1. Management of Patients With Chronic Pulmonary Disease

2. Chronic Obstructive Pulmonary Disease and Associated Respiratory Diseases
Characterized by airflow limitation that is not fully reversible (chronic bronchitis and emphysema)
Patient care
Causes airflow obstruction in the airways or obstruction in the parenchyma of the lung, or a combination of both
Asthma has abnormal airways characterized primarily by reversible inflammation

3. Pathophysiology of COPD
Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases
Chronic inflammation damages tissue
Scar tissue in airways results in narrowing
Scar tissue in the parenchyma decreases elastic recoil (compliance)
Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (pulmonary hypertension)

4. Chronic Bronchitis
Cough and sputum production for at least 3 months in each of 2 consecutive years
Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways
Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes
The patient is more susceptible to respiratory infections

5. Pathophysiology of Chronic Bronchitis
Figure 24-1

6. Question
Is the following statement true or false? For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia.

7. Answer
False For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of sputum and productive cough.

8. Emphysema
Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
Decreased alveolar surface area increases in “dead space,” impaired oxygen diffusion.
Hypoxemia results
Increased pulmonary artery pressure may cause right- sided heart failure (cor pulmonale)

9. Changes in Alveolar Structure
Figure 24-2

10. Normal Chest vs. Barrel-Shaped Chest
Figure 24-3

11. Typical Posture of a Person With COPD
Figure 24-4

12. What is the primary clinical symptom of emphysema?
Question
What is the primary clinical symptom of emphysema?
Chest pain
Productive cough
Sputum
Wheezing

13. The primary symptom of emphysema is wheezing.
Answer
Wheezing
The primary symptom of emphysema is wheezing.
Sputum and productive cough are the primary symptoms of chronic bronchitis.

14. Nursing Process for Patients With COPD
Health history
Inspection and examination findings
Review of diagnostic tests
MDI patient education, refer to Chart 24-4
Nursing Care Plan, refer to Chart 24-5
Home care check list, refer to Chart 24-6

15. Question
Is the following statement true or false? A commonly prescribed methylxanthine is theophylline

16. True A commonly prescribed methylxanthine is theophylline.
Answer
True A commonly prescribed methylxanthine is theophylline.

17. Bronchiectasis
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles
Caused by:
Airway obstruction, pulmonary infections
Diffuse airway injury
Genetic disorders
Abnormal host defenses
Idiopathic causes

18. Bronchiectasis: Clinical Manifestations and Medical Management
Chronic cough
Purulent sputum in copious amounts
Clubbing of the fingers
Postural drainage
Chest physiotherapy
Smoking cessation
Antimicrobial therapy

19. Bronchiectasis: Nursing Management
Focus is on alleviating symptoms and clearing pulmonary secretions
Patient teaching

20. Asthma
Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production
Inflammation leads to cough, chest tightness, wheezing, and dyspnea
Peak flow monitoring
Action plan

21. Medications Management for Asthma
Stepwise
Quick-relief medications
Beta2-adrenergic agonists
Anticholinergics
Long-acting medications
Corticosteroids
Long-acting beta2-adrenergic agonists
Leukotriene modifiers

22. Metered-Dose Inhalers and Spacers
Figure 24-5

23. Patient Teaching How to identify and avoid triggers
Proper inhalation techniques
How to perform peak flow monitoring
How to implement an action plan
When and how to seek assistance

24. Using a Peak Flow Meter
Figure 24-9

25. Cystic Fibrosis
Most common autosomal recessive disease among the Caucasian population
Genetic screening to detect carriers
Genetic counseling for couples at risk
Genetic mutation changes chloride transport which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract
Respiratory infections are the leading cause of morbidity and mortality