Diseases
of the
Lower Respiratory
System
Nursing II
Valencia Community College
The client with
CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE
COPD


Description
– Chronic airflow obstruction
 Irreversible
– Chronic bronchitis and/or emphysema
Incidence
– 13.5 million Americans have bronchitis
– 2 million Americans have emphysema
– 4th leading cause of death
– Death rate still rising
– 2nd cause of disability in people > 65
COPD (cont.)

Risk Factors
–
–
–
–
–
–
–
SMOKING
Age
Male gender
Air pollution
Occupational exposure
Respiratory infections
Familial & genetic factors
COPD (cont.)

Pathophysiology
– Slow, progressive
– Exacerbations  destructive changes
– Usually have both chronic bronchitis and
emphysema

And frequently asthma
Emphysema Patho



Loss of lung elasticity
Hyperinflation of the lungs
Alveolar walls and small airways
damaged
– Airways narrow or collapse
– Air trapping
– Alveolar damage = poor gas exchange
Chronic Bronchitis Patho





Inflammation caused by chronic
irritation
Cause vasodilation → congestion →
edema → bronchospasm
 mucous production
Thickened bronchial walls
Narrowing of airways = poor gas
exchange
Diagnostics



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
ABG
Sputum C & S
CXR
CBC
Electrolytes
Pulmonary function
testing
Genetic testing
Manifestations of COPD


Absent or minor early
Client usually seeks care after 10 yrs of
signs and symptoms
– When ADLs affected
Manifestations

General Appearance
– Thin with loss of
muscle mass in arms
and legs
– Stooped posture
– Slow moving
Manifestations

Respiratory
– Shallow, rapid respirations
– Use of accessory muscles
– Crackles, rhonchi, distant breath
sounds
– Dyspnea
– Barrel chested
– Bronchitis;

Cyanotic, increased mucus, clubbing,
cough
Manifestations

Cardiac
– Tachycardia
– Irregular pulse
– Dependent edema

JVD
– Clubbing
– Emphysema:


Cyanosis with
advanced disease
Pallor
Manifestations

Psychosocial
– Isolation
Fatigue
 Embarrassment
 Smoking

– Negative self image

Change in role
– Anxiety and fear
Collaborative Care

Impaired Gas Exchange
– Patent airway = pulmonary toilet
– Assess frequently
– Oxygen

Keep O2 sat > 88%
– Medications
– Energy management
– Surgical
Lung transplant
 Lung reduction

Collaborative Care

Ineffective Breathing Pattern
– Teach effective breathing techniques
Pursed lip
 Diaphragmatic/Abdominal

– Exercise conditioning

Respiratory rehab
– Energy Conservation

Rest between ADLs
Collaborative Care

Ineffective Airway Clearance
– Effective coughing

Controlled coughing
– Chest PT
– Postural drainage/positioning
– Suctioning
– Hydration

Careful if bronchitis present
Collaborative Care

Nutrition: Less Than Body Requirements
– Small, frequent meals


–
–
–
–
High calorie, high protein, low sodium
Pulmocare
Oral hygiene
Rest before meals
Assist with eating
No treatments at meal time
Collaborative Care

Anxiety
– Inform patient of all aspects of care
– Know what to do if ↑ in signs and
symptoms
– Support group
– Complementary therapy
Collaborative Care

Activity Intolerance
– Pacing activities
– Assess during activities for hypoxia
– May need supplemental O2
Collaborative Care

Potential For Infection (Respiratory)
– Flu and Pneumonia vaccines yearly
– Avoid large crowds
Home Care
– Infection prevention
– Breathing exercises
– ADL assistance
– Pulmonary rehab
program
– Dealing with chronic
illness
– May need a social
worker
The Client with
Pneumonia
Definition


Excess fluid in lungs from
inflammatory process
Types
– Infectious → Viral or Bacterial
Community acquired
 Nosocomial

– Inhalation of Irritants
Incidence



2 – 4 million cases in US yearly
5th leading cause of death
 incidence
– Elderly
– LTC residents
– Hospitalized clients
– On ventilators
Incidence Continued


More in fall and winter months
Community acquired > nosocomial
Risk Factors

Community Acquired
– Older Adult
– No pneumococcal or flu vaccines
– Chronic illness
– Smoking
– Alcohol
– Exposure to viral or bacterial infections
Risk Factors Continued

Nosocomial
– Older adult
– COPD
–  LOC
– Aspiration
– Poor nutrition
– Immune suppressed
– Mechanical ventilation
Pathophysiology





Organism invades airway
Multiples in alveoli
Inflammation in interstitial spaces,
alveoli, and bronchioles
Fluids collect in alveoli
 gas exchange
Patho Continued

Fibrin and RBCs move into alveoli
– Causes stiffening =  compliance



Alveoli collapse
Consolidation occurs
Infection spreads to other lung areas
Sites of Pneumonia

Lobar pneumonia
– Segment or lobe of the lung

Bronchopneumonia
– In bronchus and bronchioles
Diagnostics


ABGs
CBC, Lytes
– May need HIV testing



Sputum gram stain and C & S
CXR
Bronchoscopy
Manifestations

General Appearance
– Flushed

fever
– Anxious
– Muscle weakness
– Headache
– Chills
– Poor appetite
Manifestations

Respiratory
– Productive cough
– Tachypnea, orthopneic
– Use of accessory muscles
– Crackles, wheezing
– Pleuritic pain
Complications of
Pneumonia
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Hypoxemia
Respiratory failure
Atelectasis
Pleural effusion
Pleurisy
Empyema
Sepsis
Collaborative Care

Impaired Gas Exchange/Airway
Clearance
– Oxygen
– Pulmonary toilet
– Effective cough
– Hydration
– Medications
Collaborative Care

Acute Pain
– Medicate for effective coughing

Splinting
– Positioning
Collaborative Care

Fluid Volume Deficit

Disturbed Sleep Patterns

Potential for Sepsis
– What interventions would you do?
Home Care


Inquire about medical equipment for
home use
Activity tolerance