Chronic Obstructive Pulmonary Disease (COPD)
- Clinical Manifestations: chronic cough, sputum production, DOE, and progressive; weight loss.
- Medical Management: smoke cessation, bronchodilators/corticosteroids
- Nursing Assessment: determine current symptoms.
- Nursing Management:
- Achieving Airway Clearance: Monitor for dyspnea and hypoxemia, pharmacologic therapy, measure expiratory flow rates and volumes; postural drainage, chest physiotherapy
- Improving Activity Tolerance
- Improve Breathing Patterns
- Monitor for Complications’
Emphysema
Abnormal distention of the airspaces → destruction of the walls of the alveoli. Due to its resultant appearance, it is termed as the “Pink Puffer” disease.
- Clinical Manifestations: barrel chest, severe dyspnea, thin-framed body
- Diagnostics: incentive spirometry, CXR, hyperinflation + flattened diaphragm, arterial blood gases (mild-mod hypoxemia, respiratory acidosis)
Chronic Bronchitis
The presence of cough and sputum daily for at least 3 months in at least two consecutive years. Inflammation and sputum production results in increased mucus-secreting cells, and further increases mucus production. Blockage of the airways reduces ciliary function. Due to its resultant appearance, it is termed as the “Blue Bloater” disease.
- Clinical Manifestations: chronic productive cough, weight gain, elevated hemoglobin (compensatory), wheezing, peripheral edema
- Diagnostics: incentive spirometry, arterial blood gases (mild-mod hypoxia, respiratory acidosis), at least 3 months of daily chronic coughing in two consecutive years.
- Complications: RSHF, Pneumonia, Pneumothorax
Emphysema and Chronic Bronchitis
- Nursing Management: low flow oxygen (2-3 L/min) via a Venturi mask; semi-/high-fowler’s position; teaching pursed-lip breathing; chest physiotherapy
- Pharmacologic Management: bronchodilators (beta-2 agonists, anticholinergics), steroids, methylxanthines
- Dietary Management: high calorie, high protein diet
Bronchiectasis
A chronic, irreversible dilatation of the bronchi and bronchioles. It may be caused by various processes (airway obstruction, airway injury, infections, genetic disorders, abnormal host defenses, idiopathy.
- Clinical Manifestations: consistent productive cough, dyspnea, and rales/crackles.
- Diagnostics: ABG (hypoxemia), Bronchoscopy
- Nursing Management: force fluids, low-flow oxygen, CBR, COPD medications
Bronchial Asthma
Hyperresponsivity of the lungs in mucosal edema and production.
- Clinical Manifestations: coughing, wheezing, and dyspnea (triad); bronchospasm causes difficulty in exertion and may progress, leading to central cyanosis and hypoxia.
- A continuous reaction is status asthmaticus, a potentially fatal state.
- Accompanying allergic manifestations along with asthma: rashes, eczema, edema.
- Diagnostics: family, environmental, and occupational history; in acute episodes, sputum/blood tests, pulse oximetry, ABG (hypocapnia and respiratory alkalosis) and pulmonary function tests
- Medical Management: mainly pharmacologic. Long-acting control and quick-relief medications are available: short-acting beta-adrenergic agents, anticholinergics, corticosteroids, methylxanthines.
- Nursing Management: assess respiratory status (breath sounds, flow rate, pulse oximetry, vital signs), assess family history of pharmacologic allergies, teach self-care.