COPD Neoplasms Respiratory Meds

1. COPDNeoplasms Respiratory Meds PN 132

2. Learning Objectives • Define pathophysiology of common chronic respiratory disorders • Discuss nursing interventions for patients with chronic respiratory disorders • Define pathophysiology of malignant neoplasms (Lung Cancer) in the respiratory tract • Discuss nursing interventions for patients with respiratory neoplasms • Identify common respiratory medications

3. COPD Chronic Bronchitis Asthma Bronchiectasis

4. What is COPD? • Progressive and irreversible condition • Diminished inspiratory and expiratory capacity of lungs • Obstructs flow of air to or from the bronchioles – chronic airflow limitations • Includes • Emphysema • Chronic bronchitis • Asthma • Bronchiectasis

5. Chronic Bronchitis

6. Etiology and Pathophysiology • Recurrent productive cough for minimum of 3 month / year for at least 2 years • Caused by physical or chemical irritants and recurrent lung infections • Cigarette smoking most common cause • Other causes • Workers inhaling dust (coal / grain) • Underlying process • Impairment of cilia (can’t move secretions) • Mucous gland hypertrophy • Causes hyper secretion  alters cilia function • Bronchial tubes become inflamed and scarred • Patient cannot clear mucus  becomes medium for bacteria • Leads to bronchospasms • Poor O2 / CO2 exchange  increased CO2 in the blood

8. Clinical Manifestations • Productive cough • Most pronounced in the morning • Increased dyspnea • Uses accessory muscles • Cor Pulmonale • Right side heart hypertrophy  pulmonary hypertension • Cyanosis • Often accompanied by right ventricular failure • Characteristic reddish-blue skin

9. Assessment • Subjective • Hx of smoking or exposure to irritants • Family history of respiratory disorders • Current medications and treatment regimen • Objective • Assess productive cough • Characteristics and amount of sputum • Assess severity of dyspnea • Note wheezing • Patient’s level of restlessness and anxiety • Monitor vital signs • Tachycardia • Tachypnea • Elevated temp

10. Nursing interventions • Teach • Effective breathing techniques • Avoid infection exposure • Notify MD at first sign of respiratory infection • Changes in sputum • Provide medication teaching • Stress adequate fluid intake • Encourage smoking cessation program • Hydration to liquefy secretions • Suction prn • Provide “low-flow” oxygen (1 – 2 L via nasal cannula) • Maintain SpO2 > 90% • Frequent oral hygiene • Frequent rest periods • Counsel about smoking cessation • Assess • Degree of dyspnea • Use of sternal muscles for breathing • Degree of fatigue • Administer medications

11. Asthma

12. Etiology and Pathophysiology • Intrinsic • Often triggered by respiratory infection • Recurrence of attacks affected by • Mental / physical fatigue • Emotional factors • Wide spread narrowing of the airways • Extrinsic • Caused by external factors • Pollen • Dust • Feathers • Animal dander • Foods

14. Clinical manifestations • Acute Asthma Attack • Usually happens at night • Tachypnea • Tachycardia • Diaphoresis • Chest tightness • Cough • Expiratory wheezing (caused by forcing air out) • Use of accessory muscles • Nasal flaring • Increased anxiety • Thick copious mucus • Mild Asthma • Dyspnea with exertion • Wheezing • Symptoms usually controlled with medication • Status Asthmaticus • Severe, life-threatening attack • Does not respond to usual treatment • Trapped air leads to exhaustion and respiratory failure

15. Assessment • Objective • Assess s/s hypoxia • Restlessness • Inappropriate behavior • Elevated pulse and B/P • “hunched forward” • Inspiratory and expiratory wheezes • Thick stringy mucus • Subjective • c/o anxiety • Fear of suffocation • Breathlessness • Chest tightness • Cough • At night and early morning

16. Nursing interventions • Teach • Effective breathing • Lip-pursed breathing • Correct use of peak flow meter • Administer medications • Ensure adequate fluid intake and optimal ventilation • Rest with activity • Elevate HOB • O2 • Monitor vital signs • Monitor electrolytes • Empathetic emotional support!

17. Bronchiectasis

18. Etiology and pathophysiology • Abnormal / permanent dilation of one or more large bronchi • Eventually destroys musculature and elastic support of bronchial wall • Gradual loss of pulmonary muscle tone after repeated infections • More difficult to clear mucus from the lungs • Decreased expiratory air flow • Occurs as complication of recurrent inflammation and infection • Usually secondary to failure of normal lung tissue defenses • Cystic fibrosis • Foreign body • tumor

20. Clinical manifestations • S/S occur after respiratory infection • Late S/S • Dyspnea • Cyanosis • Clubbing fingers • Coughing on arising in the morning and when laying down • Copious amounts of foul-smelling sputum • Fatigue • Weakness • Loss of appetite

21. assessment Objective • Lung auscultation • Fine crackles and wheezes in lower lobes • Prolonged expiratory phase • Increased dyspnea • Hemoptysis (50%) of patients Subjective • Report of • Difficulty breathing • Weight loss • Fever

22. Nursing interventions • Teach • Avoidance of • Smoke • Fumes • Irritating inhalants • Discourage smoking • Rest with activity • Medication teaching • s/s of secondary infection • Cool mist vaporizer • Increase fluid intake • Assess vital signs and lung sounds q 2 – 4 h • Suction prn • Assist with coughing, deep breathing q2h

23. Neoplasms

24. Lung Cancer

25. Etiology / Pathophysiology • Leading cause of death from cancer in both men and women • Tumors -result from anywhere in the body -primary tumor -metastases from the colon and the kidney are common.

27. Etiology / Pathophysiology • 80-90% of lung tumors • linked to cigarette smoking • passive smoking • breathing in side stream smoke • Secondhand smoke • risk for the development of lung cancer in non-smokers • History of smoking for 20 years or more -prime risk factor for lung cancer

28. Etiology / Pathophysiology • Occupational hazard risk factors • Asbestos • Radon • uranium • Air pollution may also increase one’s risk. • Mortality • specific type of cancer • size of the tumor when it is detected.

29. Types of Lung Cancer • Classified by microscopic study of the tumor • Treatment is specific to • the type • extent of the disease (staging) • Tumor type and staging • Small cell Ca (oat cell) • Non small cell Ca • Squamous cell Ca • Large cell Ca • Most people who develop the disease are older than 50

30. Medical Management • 1/3 are inoperable when first seen • Surgical mortality • 10% pneumonectomy • 2 – 3% lobectomy • Lobectomy and segmental resection requires chest tube insertion • Pneumonectomy • Removal of the entire lung • Lobeectomy • Removal of affected lung lobe • Segmental resection • Only a portion of the lung lobe is removed • Radiation and Chemotherapy

31. CLINICAL MANIFESTATIONS • Asymptomatic in the early stages • Lesion perforates the pleural space • Pleural effusion • Severe pain • Central lesions • Obstruction • Erosion of the bronchus

32. CLINICAL MANIFESTATIONS • Cough • Hemoptysis • Fever • Dyspnea • Chills

34. Superior vena cava syndrome • Invasion of the tumor into the superior vena cava • edema of neck and face

35. ASSESSMENT OBJECTIVE • Cough • Dry • hacking • Moist • factors that relieve the cough • Sputum • Consistency • Amount • Frequency • Duration • Precipitating factors • Auscultate the lungs • Unilateral wheezing • Crackles SUBJECTIVE • Chronic cough • Hoarseness • Weight loss • Extreme fatigue • Family history of cancer • History of cigarette smoking • Exposure to occupational irritants.

36. NURSING INTERVENTIONS • Whether treatment offers comfort or cure • Patient needs comprehensive nursing interventions • Consider: • Patient’s quality of life • Education • Needed emotional support • Symptom management.

37. NURSING INTERVENTIONS – post-op • Prevention of complications • Effective airway clearance • Frequent repositioning • Cough/deep breathing • Use of incentive spirometer • Prevention of circulatory problems • encourage exercise of legs and feet

38. NURSING INTERVENTIONS • Oxygen • Vital signs • I&O • Pulse oximetry • Monitor labs • Repositioning • IV administration • Check patency of chest tubes if in use • Medication Administration • Analgesics • Antineoplastics • antiemetics

39. PATIENT/FAMILY TEACHING • Effective coughing techniques • Physical mobility • Nutrition -diet high in protein and calories -2000 mL of fluids per day (unless contraindicated) • Discourage smoking

40. Respiratory Medications PN 132

41. Nasal Decongestants Adrenergics • Ephedrine (Vicks) • Oxymetazoline (Afrin) • Phenylephrine (Neosynephrine) Intranasal Steroids • Beclomethasone dipropionate • Beconase • Vancenanse • Flunisolide (Nasalide)

42. Oral Decongestants • Prolonged effects • Less potent • No rebound congestion • Exclusively adrenergics • Example: Pseudoephedrine (Sudafed)

43. Topical Decongestants • Adrenergics-Prompt onset -Sustained use Rebound Congestion • Both adrenergics and steroids -Potent - work well

44. Nasal Steroids • Anti-inflammatory -Decrease inflammation -Relieve nasal congestion

45. Nasal Decongestants: Side Effects Adrenergics • Nervousness • Insomnia • Palpitations • Tremors Steroids • Local mucosal dryness and irritation • Candida infections

46. Disorders Treated withNasal Decongestants • Acute or chronic rhinitis • Common cold • Sinusitis • Hay fever • Other allergies

47. Nasal Decongestants Nursing Implications • Avoid decongestants in the following clients: • Heart disease • Hypertensive disease • Respiratory Disease • Assess for drug allergies

48. Bronchodilators • Can be aerosolized to relax and open the bronchial airways. • Can treat several disease syndromes • COPD • Asthma

49. Bronchodilators • Classes of Bronchodilators: • Sympathomimetic Agents • Xanthine Bronchodilators • Anticholinergics • Leukotriene Receptor Antagonists • 5-lipoxygenase inhibitors • Mast Cell stabilizers • Corticosteroids

50. Bronchodilator Administration • Use of an Inhaler • MDI (Multi-dose inhaler) is also called a rescue inhaler, it delivers a puff of medication that is inhaled. • Nebulizer dispenses a larger dose of the bronchodilator over a longer duration in the form of a mist that is breathed in.