Lecture 4: COPD, Asthma, Obstructive Sleep Apnea

med-surg notes Lecture 4: January 27 COPD, Asthma, Obstructive Sleep Apnea Etiology of Obstruction Asthma Assessment Asthma zistorp Intermittent and reversible obstruction Dhpsical assessmentHclinical mani:estations Inwammation or airyap hpMerresMonsiveness Audible yheeRe- increased UU fani:estations, fucosal edema- bronchoconstricx tion- eCcessive mucus Mroduction Increased cou2h "se o: accessorp muscles OPDE B(arrel chestB :rom air traMMin2 LmMhpsema gon2 breathin2 cpcle goss o: lun2 elasticitp and hpMerinwation o: lun2 tissue Opanosis )Gn2ertiMsF zpMoCemia Eestruction o: alveoli and decreased sur:ace area :or 2as eCchan2e gaboratorp Assessment A(Vs OP/ retention- resMiratorp acidosis Dulmonarp :unction tests Ohronic bronchitis 1orced vital caMacitp )1kOF Inwammation o: bronchiHbronchioles due to chronic eCMosure to irritants 1orced eCMiratorp volume in Grst second )1LkSF Dea3 eCMiratorp woy rate Asthma Interventions 0el:xfana2ement Lducation Dersonal asthma action Mlan Avoid tri22ers )environmental- dru2s- :oodF I: eCercisedxinduced- use bronchodilator qK mins be:ore eCercise Vet adeTuate rest fonitor Mea3 eCMiratorp woy rate yith a woy meter T/d COPD Laboratory Assessment Xnoy yhen to see3 emer2encp helM DroMer inhaler and sMacer use A(V values :or abnormal oCp2enationventilation- acidxbase status Eru2 &heraMp Oontrol theraMp dru2s )used dailpF 0Mutum samMles Ueliever dru2s )to stoM an attac3F O(O (ronchodilators zemo2lobin and hematocrit Antixinwammatorp a2ents 0erum electrolptes Dyspnea Assessment Tool 0erum AA& Ohest .U Dulmonarp :unction test Chronic Obstructive Pulmonary Disease Ltiolo2p W Drevalence Vreatest ris3, Oi2arette smo3in2 AlMhaxSxantitrpMsin deGciencp Incidence and Mrevalence, 1ourth leadin2 cause o: mortalitp and morbiditp in the "→0→ OomMlications zpMoCemiaHtissue hpMoCia Acidosis UesMiratorp in:ections )acute on chronicF Oardiac :ailure- esMeciallp cor Mulmonale Oardiac dpsrhpthmias )atrial dpsrhpthmiasF Nonsurgical Management InterMro:essional Oollaborative Oare Assessment, Ueco2niRin2 cues (reathin2 techniTues zistorp Dositionin2 Veneral aMMearance L9ective cou2hin2 UesMiratorp chan2es PCp2en theraMp Oardiac chan2es Eru2 theraMp Planning & Implementation LCercise conditionin2 Veneratin2 0olutions W &a3in2 Actions 0uctionin2 Tripod Position Dts yith endxsta2e OPDE map adoMt Mosix tions that relieve dpsMnea geanin2 :oryard yith arms outx stretched and yei2ht suMMortx ed on the MalmsHelboys ImMrove zpdration Drevent 0mo3in2 cessation Eecreased 2as eCchan2e finimiRe AnCietp Increase 0ur2ical treatment, gun2 rex duction sur2erp COPD Assessment Cues & Hypotheses 4ei2ht loss Eecreased endurance Dotential :or Mneumonia Drug Therapy (etaxadrener2ic a2ents Oholiner2ic anta2onists Hypoxic Respiratory Drive Care Coordination & Transition Management zome care mana2ement, fethpCanthines gon2xterm use o: oCp2en Oorticosteroids )inhaled W spstemicF Dulmonarp rehabilitation Mrox 2ram fucolptics fonitor Mt use % doynre2ux lation o: beta a2onist receMx tors Evaluate Outcomes 0el:xmana2ement education, Eru2 theraMp fani:estations o: in:ection (reathin2 techniTues UelaCation theraMp zealthcare resources Obstructive Sleep Apnea (OSA) Etiology LMisodic- sleeMxstate deMendent collaMse o: uMMer airyaps Deriodic reductions in cessations in ventilation zpMoCia- hpMercaMnia- arousals :rom sleeM Conditions OSA Impacts Drevalence zpMertension qKx57, q> yomen- SK> men fetabolic spndrome ;Kx6K, 7> yomen- S6> men OSA Management Lstimated /5 million in "→0→ undia2nosed onsur2ical Uis3 1actors Anpthin2 that reduces the siRe o: the restin2 MharpnC or increase airyap collaMsibilitp fost imMortant, Pbesitp Dresent in more than 5K> o: MeoMle yith a (fI N qK metabolic spndrome K> o: MeoMle yith fale N :emale zpMothproidism Eiabetes fpocardial in:arction Ohan2e o: sleeM Mosition Atrial Gbrillation 4ei2ht loss 0tro3e DositivexMressure ventilation )ODADF zeart :ailure 0ur2ical Adenoidectomp "vulectomp "vuloMalatoMharpn2oMlastp Ee2enerative neurolo2ical conx ditions Dneumonia AsthmaHOPDE Acrome2alp gar2e tonsils or adenoids CPAP & BiPAP Use &he mana2in2 gID yill loo3 to the Mroblem list to determine settin2s &he gID yill order the settin2s :or MostxoM use 0ettin2s should include ODADH(iDAD levels- IDADHLDAD levels- and )i: on homexoCp2enF the liter woy rate 4here Mossible- Mts should be instructed to brin2 machine to hosMital on dap o: sur2erp- alon2 yith their current MrescriMtion :or MositivexMressure theraMp U HU& yill ensure ODADH(iDAD eTuiMment has been chec3ed bp clinical en2ineerin2 )OLF and a yaiver has been si2ned bp the Mt I: the Mt does not have their home device- U& should be consulted :or evaluation and initiation o: ODADH(iDAD Nursing Considerations Oollaborate yith resMiratorp theraMp fonitor resMonse to theraMp fonitor s3in Dt education, OomMliance and cleanin2Hmaintenance o: machine Oonsider sleeM aMnea yith other conditions gi:estple modiGcations PCimetrp, &he 0MP/ and UU should be monitored T5h and documented- as should comMliance yith ODADH(iDAD continue :or a minimum o: /5 hours Additional monitorin2 individualiRed based on gID assessment Oare team should re:er to the P0A &reatment Prder 0et