ology and Pathophysiology

rette smoking, air pollution or occupational substanc

Causes irritation of the airways resulting in
hypersecretion of
of mucus and inflammation
Constant irritation causes the mucussecreting glands and
goblet cells to increase in number
Ciliary action is reduced and more mucus is
produced

CHRONIC BRONCHITIS
disease of the airways, is defined as the
presence of
cough and sputum production for at least 3
months in
each of two consecutive years. It is a disorder
of chronic
airway inflammation

Planning and Implementation

Assist client to develop appropriate nutritional plans that
Provide adequate calories but maintain ideal weight.
Administer supplemental low-flow oxygen as necessary, be
Prepared to initiate mechanical ventilation
Medical Therapy
Immunize against pneumonia and influenza
Antibiotics
Give bronchodilators controversial use in COPD but
maintenance therapy may be used to reduce dyspnea
> beta-adrenergic agonists used as bronchodilators
In COPD and administered by nebulizer and MDI

>Anticholinergics Ipratropium is administered and is

considered one of the most effective bronchodilators for COPD
>Long- acting Theophylline controversial use in COPD but
may be beneficial to strengthen diaphragm contractility and
decrease work of breathing
>Corticosteroids is given which may be beneficial for clients
with asthma or with frequent exacerbations unresponsive to
therapy with beta-agonists medications.
Client education
>Smoking cessation
Nutritional therapies for adequate energy needs and weight
Management.

Asthma
Chronic inflammatory disease of the airways that causes
airway hyperresponsiveness, mucosal edema and mucus
production.
Pathophysiology
Predisposing factors : Atopy/ female gender
Causal Factors : Exposure to indoor and outdoor allergens
Occupational sensitizers
Contributing factors : RI, Air pollution,active/passive smoking
other (diet, SGA)
Risk factors- allergens, RI, exercise and hyperventilation
weather changes, exposure to sulfur dioxide, exposure to food,
additives and medications

Inflammation
Hyperresponsiveness
of airways

Airflow limitation
(wheezing,cough,
Dyspnea and ches
Tightness)

Clinical Manifestations
>Cough
>Severe dyspnea
>wheezing on expiration
>feelings of chest tightness
Prolonged expiration are noted
Mild to greatly diminished breath sounds upon
auscultation
Hyperresonant sound or percussion
Increased heart rate and BP
extreme restlessness, anxiety and agitation
Tachypnea with use of accessory muscles

Diagnostic and laboratory findings

Decreased pO2, mild respiratory alkalosis
Elevated eosinophil count
Increased residual volume, decreased vital
capacity
Priority Nursing Diagnosis
Ineffective breathing pattern
Ineffective airway clearance
Risk for infection
Anxiety
Planning and Implementation
Allergy desensitization therapy if appropriate
Diagnostic testing during non-acute period
includes

CXR, pulmonary function studies, allergy skin testing

,serum
Eosinophils and IgE
Medication therapy
-Short acting beta-agonist inhaler :: used for mild
symptoms
-Anti-inflammatory inhaler : used for mild symptoms
occurring daily
-Anti-inflammatory inhaler plus medium dose
corticosteroid
Inhaler :symptoms occurring daily or more often
Anti-inflammatory inhaler plus long-acting
bronchodilator
Plus oral corticosteroid-used for severe symptoms
occurring
Daily or more often

Therapeutic management
-Acute episodes are managed with inhaled beta
agonists,
Bronchodilators,anti-inflammatory agents,
corticosteroids
And oxygen therapy. In severe cases, mech vent may
be instituted.
-Chronic management includes administration
described in
the medication section
Client education
-Teach client/family about proper use of MDI
-Instruct client regarding the use of peak flow meter
for selfassessment of asthma status

Restrictive to Lung and/or Alveolar Expansion

Pneumothorax : air accumulation in the pleural space

1. Spontaneous rupture of air-filled bleb that allows pathway

for air movement between respiratory system and pleural
space; collapse of involved tissue may seal leak with minimal
client symptoms; air leak may progress until pressure between
thoracic cavity and atmosphere equalizes and client is
symptomatic.
-Primary :spontaneous rupture of bleb in an otherwise
healthy individual; occurs more often in tall slender males aged 2040
-Secondary : rupture of overly distended alveoli, occurs in
individuals with known COPD

2. Tension : disruption of the chest wall or lungs causes air

accumulation in the pleural space; pressure on the mediastinum
causes pressure on the other lung and interrupts venous return
to the heart. It is a medical emergency that requires emergency
placement of chest tube to relieve increasing pressure in the
thoracic cavity to restore adequate cardiac output.
3. Traumatic : disruption of the pleura, bronchi, or lung tissue
caused by blunt or penetrating trauma with air accumulation
in the pressure spaces.
4. Iatrogenic: disruption of the pleura, bronchi or long tissue
during instrumentation for central venous line, lung biopsy or
thoracentesis produces unintentional air leak within respi
system.

*Hydrothorax : presence of serous fluid in the pleural

space
Due to lymphatic obstruction or by CHF
1. Assessment
Clinical Manifestations
-worsening dyspnea
-diminished or absent breath sounds
-dullness to percussion
-chest wall pain
-fever, persistent cough, night sweats and weight loss
with
empyema
Priority Nursing Diagnosis
Ineffective breathing pattern
Pain

-Risk for infection

-Hyperthermia
-Impaired gas exchange
Planning and Implementation
Thoracentesis; thoracostomy if indicated
Provide adequate nutrition with focus on adequate protein
Intake
-Analgesics
-antipyretics
-IV lipids
-Antibiotic therapy
-Surgical procedure may include decortication or the separation
Of the pleural membranes

*Hemothorax : presence of blood in the pleural space, usually

traumatic in origin
Etiology and Pathophysiology

-Normal intrapleural pressure is negative compared to atmospheric

air pressure
-Pressure difference between the thoracic cavity and the atmosphere
is one of the stimuli for breathing
-Intrapleural pressure equalizes with atmospheric air, removing
one stimuli for breathing
-Lung collapses as pressure increases in the thoracic cavity
-Preload decreases and cardiac output is compromised.

Clinical Manifestations
-dyspnea
-tracheal deviation toward the unaffected side
-diminished breath sounds on affected side
-percussion dullness on the affected side
-unequal chest expnsion
-crepitus over the chest
Diagnostic and Lab test findings
-Chest xray reveals hemothorax
-ABG shows decreased pO2

Priority Nursing Diagnoses

-Impaired gas exchange
-Risk for injury
-Ineffective breathing pattern
-Decreased cardiac output
-Risk for infection
-Pain
-Anxiety
Planning and Implementation
-Care of the client with chest tube
-Maintain infection control practices

Therapeutic Management
In mild cases, no chest tube is required unless significant
Placement of tube with water-seal drainage
For spontaneous pneumothorax-in an otherwise healthy client,
may be resolved without invasive treatment.
If spontaneous pneumothorax occurs repeatedly, pleurodesis
may be required- instillation of an agent in the pleural spaces
to allow the pleura to adhere together; other procedures include
partial pleurectomy; stapling or laser pleurodesis for pleural
sealing.
Medication Therapy
-Analgesics and antibiotics