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Respiratory Patho Chronic Obstructive Pulmonary Disease w Also called COLD-- chronic obstructive lung disease w Emphysema w Chronic bronchitis w Asthma.

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Presentation on theme: "Respiratory Patho Chronic Obstructive Pulmonary Disease w Also called COLD-- chronic obstructive lung disease w Emphysema w Chronic bronchitis w Asthma."— Presentation transcript:

1

2 Respiratory Patho

3 Chronic Obstructive Pulmonary Disease w Also called COLD-- chronic obstructive lung disease w Emphysema w Chronic bronchitis w Asthma

4 Emphysema w What is it? w Destruction of alveolar walls-- below the bronchioles w Decreases surface area w Decreases area available for exchange w Increase resistance to pulmonary blood flow

5 Emphysema cont... w Can lead to pulmonary hypertension w Cor pulmonale = right heart failure w Lungs can not recoil and air is trapped w Residual lung capacity increases w PO2 decreases over time w Increased RBC w Polycythemia-- high hematocrit

6 Emphysema cont... w PCO2 increased w Hypoxic drive w Causes w Complications of disease w Pneumonia w URI w Dysrhythmias cancer

7 Emphysema cont... w Home drugs w Bronchodilators w Steroids w Later-- oxygen

8 Emphysema cont.. w Assessment w Weight loss-- thin w Dyspnea esp on exertion w Cough only in AM w Barrel chest w Tachypnea

9 Emphysema cont.. w Pink puffers w Enlarged accessory muscles w Clubbing of fingers w Pursed lips-- prolonged expiration-- active now w Wheezing or rhonchi may or may not be present

10 Chronic bronchitis w Increase in the number of mucous cells w Large amount of sputum w Diffusion normal w Hypercarbia due to deceased alveolar ventilation

11 Chronic bronchitis w Assessment w Overweight w Blue bloaters w Rhonchi w RHF-- JVD, pedal edema

12 Management of COPD w Goal??? w Treat hypoxia w Reverse bronchoconstriction w Reassure patient-- EMONTIONAL support w Oxygen using patient distress to determine amount w Monitor for cardiac dysrhythmias

13 Management of COPD w IV 5% D/W or NS KVO w Nebulizer w Albuterol, Proventil Ventolin w isoethharine, Bronksol w metrproterenol, Alupent w Sympathomimetic, Beta agonist B2 selective

14 Management of COPD w Bronchodilation w Uses-- COPD, Pul edema, asthma, severe allergic reactions w Contraindications-- tachycardia w Monitor B/P, pulse, ECG w Side effects-- tachycardia, palpitations, anxiety,headache, dizzy

15 Asthma w Asthma patients do die w Increasing deaths over 45 years old w Higher death rate in Afro-Americians w definition w Chronic disease due to air flow obstruction w Small airways consrtict

16 Asthma w Causes of acute excerbations w allergens w cold air w irritants-- smoke, pollen w medications

17 Asthma w Phase one w Release of histamine w Bronchoconstriction and bronchial edema w Usually will respond to Beta agonist w Phase two w WBC invade bronchioles w Cause edema and swelling of bronchioles

18 Asthma w Phase 2 will not respond well to Beta agonists w May need steroids w Assessment w Dyspnea and wheezing w Cough w Hyperressonance

19 Asthma w Assessment cont. w Tachypnea w Use of accessory muscles w Speech dyspnea w History-- what did pt take w beta agonist?, steroids, anticholinergics, bronchodilators?

20 Asthma w History of admissions to hospital for asthma w Hx of intubations? w Management w Corect hypoxia, reverse bronchospasm w Treat inflammatory process

21 Asthma treatment w Emotional support w Primary and secondary survey w Oxygen w EKG and pulse ox w Beta agonist-- nebulizer w Epinephrine SQ mg or cc 1:1000 solution Peds 0.01 mg.kg up to 0.3mg

22 Asthma treatment w Aminophyllin-- Xanthine bronchodilator (not a beta agonist) w Solu Medrol--- steroid

23 Status Asthmaticus w Severe, prolonged asthma attack which can not be broken by usual treatment w Wheezing may be absent-- silent chest w Severe acidosis w May have to intubate

24 Pneumonia w More prevalent in??? w Elderly w HIV positive w Peds w Infection in the lungs w Bacterial, viral, fungal

25 Pneumonia w Assessment w “looks sick” w fever and chills w tachypnea, tachycardia w general weakness-- malaise w Productive cough-- yellow, blood-tinged w Chest pain-- upper abd pain

26 Pneumonia w Rhoncho, wheezing, rales w percussion??? w Management w Emotional support w Primary and secondary survey w O2, EKG, Pulse ox, IV-- may be dehyrated w Position, when would nebulizer be used?

27 Toxic inhalation w May cause inflammation and constriction or laryngospasm or edema of larynx w superheated air w toxic products w chemicals w inhaled steam

28 Toxic inhalation w Scene safety w If hoarseness, brassy cough or stridor-- possible laryngeal edema-- be careful w May need to intubate w Humidified O2, IV, EKG, Pulse ox w Be careful about nebulized drugs

29 Carbon monoxide w Odorless, tasteless gas w binds with hemoglobin 200 faster than oxygen w receptor sites do not transport oxygen w cellular hypoxia w history-- how long and where

30 Carbon monoxide w Signs and symptoms w headache and irritability w confusion or agitation w vomiting, chest pain, LOC, seizures w Cyanotic, cherry red is late sign

31 Carbon monoxide w Management w Remove from site w Airway, high oxygen w treat for respiratory depression or shock w Hyperbaric

32 Pulmonary embolus w Blood, air, foreign body that lodges in pulmonary artery w Many are diagnosed on autopsy w S and S w Sudden unexplained SOB w Chest pain may or may not be present w Shock symptoms

33 Pulmonary embolus wWwWho is at risk wlwlong term immoblization wBwBCP wHwHx of thrombophlebitis wDwDelivery wlwlong bone fx

34 w Management w Transport ASAP w High O2, position w Emotional support w IV, pulse ox, EKG, 12 lead w May need to tube

35 Hyperventilation syndrome w Anxiety or situational problem w consider other medical problems w do not minimize w loss of CO2 cause Respiratory Alkalosis w rapid and shallow respirations w nervous, dizzy, chest pain

36 Hyperventilation syndrome w Numbness and tingling-- mouth, hands, feet w carpopedal spasms w Treatment w EMOTIONAL SUPPORT w slow respirations

37 Central nervous system dysfunction w Head trauma, stroke, brain tumor, drugs w dysfunctional of spinal cord, nerves, respiratory muscles w spinal cord trauma, polio, myasthenia gravis, Lou Geriigh’s disease, MS, MD


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