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COPD Neoplasms Respiratory Meds

COPD Neoplasms Respiratory Meds. PN 132. 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

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COPD Neoplasms Respiratory Meds

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  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

  7. 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

  8. 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

  9. 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

  10. Asthma

  11. 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

  12. 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

  13. 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

  14. 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!

  15. Bronchiectasis

  16. 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

  17. 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

  18. 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

  19. 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

  20. Neoplasms

  21. Lung Cancer

  22. 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.

  23. 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

  24. 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.

  25. 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

  26. 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

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

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

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

  30. 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.

  31. 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.

  32. 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

  33. 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

  34. 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

  35. Respiratory Medications PN 132

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

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

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

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

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

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

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

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

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

  45. 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.

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