Asthma COPD Bb Fall 2011(1)

8/4/2019 Asthma COPD Bb Fall 2011(1)

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ASTHMA Asthma is usually a

reversible process Involves periodic

episodes


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Pathologic Changes

Hypersensitivity response Bronchoconstriction

May become chronic with irreversiblechanges


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Presentation

Bronchospasm Increased mucus secretion

Dyspnea Wheezing Cough


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pollution, pollen, exercise, mold


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Asthma

Allergic asthma istriggered when an

allergen cross-links IgEreceptors on mast cells,

which are thenactivated to releasehistamine and other

inflammatory mediators(early-phase response).A late-phase response

may occur due tofurther inflammation

. Lewis ed 8 Fig. 29-2


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Asthma

Factors causingobstruction(especially expiratoryobstruction) inasthma.

A, Cross section of a bronchiole occluded by muscle spasm,swollen mucosa, andmucus in the lumen.B, Longitudinalsection of aBronchioleLewis 8 th ed Fig 29-3


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Fig. 29-1. Pathophysiology of asthma. IL, Interleukin.


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Nursing Management:Asthma


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Asthma

Lewis 8 th ed, Fig. 29-4. Drug therapy: stepwise approach for managing asthma.


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example of medicationvia a nebulizer


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Example of an Aero Chamber spacer

used with a metered-dose inhaler


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Example of a dry powder inhaler (DPI).


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Peak Flowmeasure peak expiratory flow volume

Med Surg Nsg 5 th ed 1997, Black page 1053


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Chronic Obstructive Pulmonary

Diseases (COPD)Chronic

Airflow Limitation (CAL)Emphysema

Chronic Bronchitis


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Emphysema

Loss of lung elasticity Hyperinflation of the lung

Formation of Bullae Small airway collapse and air trapping VQ mismatching


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Effects of Tobacco Smoke on theRespiratory Stystem

Table 29-17. Effects of Tobacco Smoke on the Respiratory System.


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Emphysema: Damage of Aveoli


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Hereditary Emphysema or Alpha 1-AntrypsinDeficiency (A1AD) is an inherited disorder that resultsin low or non-existent levels of AAT in the blood.


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AAT Deficiency Alpha-1 antitrypsin (AAT) deficiency Alpha 1 is an inherited

condition in which there are low levels or no levels of AAT in theblood.

*Also known as AAT Deficiency, AATD, A 1-PI deficiency, alpha-1proteinase deficiency, A1AD, or hereditary or geneticemphysema.

Alpha-1 antitrypsin (AAT), also known as alpha 1-proteinaseinhibitor (A 1-PI), is an enzyme produced by the liver andreleased into the bloodstream.

One of the primary roles of AAT is to protect the lungs fromneutrophil elastase (NE), an enzyme released by white bloodcells. Neutrophil elastase can attack healthy lung tissue if notcontrolled by AAT.

http://www.alpha1health.com/paf/respiratory_system.html
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Disease
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Classifying Emphysema

Panlobular

Centrolobular

Ch i Ob t ti P l
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Chronic Obstructive PulmonaryDisease

and Therapy by Stages


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Client with Emphysema


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Clinical Manifestations

Progressive dyspnea on exertion Prolonged expiratory phase &

tachypnea Increased work of breathing Anorexia, weight loss

Barrel Chest Flattened diaphragm
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Clinical Manifestations (cont)

Formation of blebs and bullae Hyperresonance

Polycythemia (pink puffer) Chronic hypoxia Pneumothorax Chronic respiratory acidosis (end stage)
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Normal muscles which assist in respiration


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Accessory Muscles


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A/P diameter with COPD


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Clubbing of Fingers


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Cor Pulmonale secondary to COPD


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Consequences of patient withemphysema

ABGs Initially normal ABG followed by decreased

PaO2

and O2

saturation

Increased PaCO 2 with an increase in HCO 3 to compensate

Compensated Respiratory Acidosisand Hypoxemia
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Chest cavity/ autopsy: reveals numerous large bullaeapparent on the surface of the lungs in a patient dying

with emphysema


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Collaborative Management of COPD Medical management

Maximize oxygenation, ventilation andperfusion

Manage environment, prevent infections,smoking cessation, drug therapy, O2therapy, etc

Also see notes Surgical management

Bullectomy Lung volume reduction surgery
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Video-Assisted Lung Volume Reduction Surgery(may also be called thorascopic or endoscopic LVRS)
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Preoperative CXR of client with COPD


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Asthma COPD Bb Fall 2011(1)