Disease condition and management of Asthma, pneumonia and COPD

1. RESPIRATORY
DISORDERS
Shashikanthraddy Patil
Consultant, Management Ministry of Education Maldives

2.  The human respiratory system is a series of organs
responsible for taking in oxygen and expelling carbon
dioxide. The primary organs of the respiratory system
are lungs, which carry out this exchange of gases as we
breathe.
The respiratory system performs two major tasks:
 Exchanging air between the body and the outside
environment known as external respiration.
 Bringing oxygen to the cells and removing carbon
dioxide from them referred to as internal
respiration.

3. PARTS OF RESPIRATORY SYSTEM
 There are 3 major parts of the respiratory system:
 The airway, the lungs, and the muscles of respiration.
 The airway, which includes the nose, mouth, pharynx,
larynx, trachea, bronchi, and bronchioles, carries air
between the lungs and the body’s exterior.
 The lungs act as the functional units of the respiratory
system by passing oxygen into the body and carbon
dioxide out of the body.
 Finally, the muscles of respiration, including the
diaphragm and intercostal muscles, work together to act
as a pump, pushing air into and out of the lungs during
breathing.

6.  Breathing (pulmonary ventilation).
consists of two cyclic phases:
 Inhalation, also called inspiration
- draws gases into the lungs.
 Exhalation, also called expiration
- forces gases out of the lungs.

7. ASTHMA

8. DEFINITION
Asthma is a chronic inflammatory
disease of the airways that causes
airway hyperresponsiveness, mucosal
edema, and mucus production.

9. CAUSES
 Allergy. Allergy is the strongest predisposing factor for
asthma.
 Chronic exposure to airway irritants. Irritants can be
seasonal (grass, tree, and weed pollens) or perennial
(mold, dust, roaches, animal dander).
 Exercise.Too much exercise can also cause asthma.
 Stress/ Emotional upset.This can trigger constriction of
the airway leading to asthma.
 Medications. Certain medications can trigger asthma.

10. SIGNS AND SYMPTOMS
•Most common symptoms of asthma are cough (with or
without mucus production), dyspnea, and wheezing (first
on expiration, then possibly during inspiration as well).
•Cough. There are instances that cough is the only symptom.
•Dyspnea. General tightness may occur which leads to
dyspnea.
•Wheezing. There may be wheezing, first on expiration, and
then possibly during inspiration as well.
•Asthma attacks frequently occur at night or in the
early morning.
•Additional symptoms, such as diaphoresis, tachycardia,
and a widened pulse pressure, may occur.

11. DIAGNOSIS
 To determine the diagnosis of asthma, the clinician must
determine that episodic symptoms of airway obstruction are
present.
 Positive family history. Asthma is a hereditary disease, and
can be possibly acquired by any member of the family who has
asthma within their clan.
 Environmental factors. Seasonal changes, high pollen counts,
pet dander, climate changes, and air pollution are primarily
associated with asthma.
 Comorbid conditions. Comorbid conditions that may
accompany asthma may include gastroesophageal reflux,
drug-induced asthma, and allergic bronchopulmonary
aspergillosis.

12. MEDICAL MANAGEMENT
 Long-term asthma control medications, generally taken daily,
are the cornerstone of asthma treatment.These medications
keep asthma under control on a day-to-day basis and make it less
likely you'll have an asthma attack.Types of long-term control
medications include:
 Inhaled corticosteroids.These anti-inflammatory drugs include
fluticasone
 Leukotriene modifiers.These oral medications — including
montelukast and zafirlukast — help relieve asthma symptoms
for up to 24 hours.
 Long-acting beta agonists.These inhaled medications, which
include salmeterol and formoterol , open the airways.

13.  Theophylline.Theophylline is a daily pill that helps keep the
airways open (bronchodilator) by relaxing the muscles
around the airways. It's not used as often now as in past
years.
 Quick-relief (rescue) medications are used as needed for
rapid, short-term symptom relief during an asthma attack —
or before exercise if your doctor recommends it.Types of
quick-relief medications include:
 Short-acting beta agonists.These inhaled, quick-relief
bronchodilators act within minutes to rapidly ease symptoms
during an asthma attack.They include albuterol and
levalbuterol .

14. •Ipratropium . Like other bronchodilators, ipratropium acts
quickly to immediately relax your airways, making it easier
to breathe.
•Oral and intravenous corticosteroids. These
medications — which include prednisone and
methylprednisolone — relieve airway inflammation caused
by severe asthma. They can cause serious side effects
when used long term.

15. NURSING MANAGEMENT
1. Ineffective airway clearance related to increased
production of mucus and bronchospasm.
2. Ineffective breathing pattern related to spasm of the
airway, respiratory muscle fatigue.
3. Impaired gas exchange related to bronchospasm,
damage to the alveoli.
4. Activity intolerance related to imbalance of oxygen
supplied to the needs
5. Knowledge deficit: about asthma, related to lack of
information sources.
6. Anxiety related to crisis situations: changes in health
status

16. NURSING INTERVENTIONS
 Assess history. Obtain a history of allergic reactions to medications
before administering medications.
 Assess respiratory status. Assess the patient’s respiratory status by
monitoring the severity of symptoms, breath sounds, peak flow,
pulse oximetry, and vital signs.
 Assess medications. Identify medications that the patient is
currently taking. Administer medications as prescribed and monitor
the patient’s responses to those medications.
 Pharmacologic therapy. Administer medications as prescribed and
monitor patient’s responses to medications.
 Fluid therapy. Administer fluids if the patient is dehydrated.

17. HEALTH EDUCATION
Information about airway inflammation and
bronchospasm using figures to illustrate the concept;
methods for avoiding irritants and relevant allergens
Description of the correct use and side effects of
preventive medications and bronchodilators
Demonstration and practice of inhaler technique
Demonstration of techniques for successful
communication with health care professionals
Emphasis on the need for regular follow-up
specific information on food allergy

18. Pneumonia

19. DEFINITION
Pneumonia is an infection in one or both
lungs. Pneumonia causes inflammation in
the air sacs in your lungs, which are called
alveoli.The alveoli fill with fluid or pus,
making it difficult to breathe.
It can be caused by bacteria, viruses, or
fungi. Bacterial pneumonia is the most
common type in adults

20. SIGNS AND SYMPTOMS
The most common symptoms of pneumonia can
include:
 coughing that may produce phlegm (mucus)
 fever, sweating, and chills
 shortness of breath
 chest pain
 Other symptoms can vary according to the cause
and severity of the infection, as well as the age and
general health of the individual.

21. CLASSIFICATIONS
According to causes
 Bacterial (the most common cause of
pneumonia)
 Viral pneumonia
 Fungal pneumonia
 Chemical pneumonia (ingestion of kerosene
or inhalation of irritating substance)
 Inhalation pneumonia (aspiration
pneumonia)

22. CLASSIFICATIONS
According to areas involved
 Lobar pneumonia; if one or more lobe is
involved
 Broncho-pneumonia; the pneumonic
process has originated in one or more
bronchi and extends to the surrounding
lung tissue.

23. DIAGNOSTIC EVALUATION
History taking
Physical examination
Chest x-ray
Blood test
Sputum culture

24. MEDICAL MANAGEMENT
 Antibiotic, antiviral, and antifungal drugs are used to
treat pneumonia, depending on the specific cause of the
condition.
 Most cases of bacterial pneumonia can be treated at
home with oral antibiotics, and most people respond to
the antibiotics in one to three days.
 Medication to relieve your pain and fever, as needed.
These may include aspirin, ibuprofen, and
acetaminophen.
 Oxygen therapy
 Chest physiotherapy

25. NURSING DIAGNOSIS
Ineffective airway clearance related to increased
sputum production
Impaired gas exchange related to Alveolar-capillary
membrane changes (inflammatory effects)
Risk for Fluid Volume Deficit related to fever and
vomiting
Acute pain related to persistent cough
Knowledge Deficit about the condition and the need
for action.

26. NURSING INTERVENTION
Maintain a patent airway and adequate oxygenation.
Obtain sputum specimens as needed.
Use suction if the patient can’t produce a specimen.
perform chest physiotherapy.
Provide a high calorie, high protein diet of soft foods.
To prevent aspiration during nasogastric tube feedings,
check the position of tube, and administer feedings slowly.
To control the spread of infection, dispose secretions
properly.

27. Chronic obstructive pulmonary disease
COPD

28. DEFINITION
Chronic obstructive pulmonary disease
(COPD) is a lung disease characterized by
chronic obstruction of lung airflow that
interferes with normal breathing and is not
fully reversible.
This disease is characterized by increasing
breathlessness.

29. CAUSES
Exposure to pipe, cigar, tobacco
smoke
Exposure to second hand smoke
Exposure to heavy air pollution
Exposure to heavy dust
Exposure to chemical/toxic fumes

30. SIGNS AND SYMPTOMS
Increased breathlessness
Frequent coughing (with and without
sputum)
Wheezing
Tightness in the chest
Chest infection
Weight loss, tiredness and ankle swelling.

31. DIFFERENCE BETWEEN
COPD AND ASTHMA
In COPD there is permanent damage to the
airways. The narrowed airways are fixed, and so
symptoms are chronic (persistent). Treatment to
open up the airways, is therefore limited.
In asthma there is inflammation in the airways
which makes the muscles in the airways
constrict. This causes the airways to narrow. The
symptoms tend to come and go, and vary in
severity from time to time. Treatment to reduce
inflammation and to open up the airways usually
works well.

32. DIAGNOSTIC TESTS
Symptoms
Physical examination
Sample of sputum
Chest x-ray
High-resolution CT (HRCT scan)
Pulmonary function test (spirometry)
Arterial blood gases test
Pulse oximeter

33. MEDICAL MANAGEMENT
 Antibiotics to treat infection
 Bronchodilators to relieve bronchospasm, reduce
airway obstruction, mucosal edema and liquefy
secretions.
 Chest physiotherapy and postural drainage to improve
pulmonary ventilation.
 Proper hydration helps to cough up secretions or
tracheal suctioning when the patient is unable to
cough.
 Steroid therapy if the patient fails to respond to more
conservative treatment.

34. MEDICAL MANAGEMENT CONT...
Stop smoking
Oxygenation with low concentration during
the acute episodes
Sedatives to calm the patient.
Increase fluids intake to correct loss of
diaphoresis and inaccessible loss of
hyperventilation.
Intubations and mechanical ventilation if
there is respiratory failure.

35. NURSING DIAGNOSIS
1. IneffectiveAirway Clearance related to
bronchoconstriction, increased sputum production and
ineffective cough.
2. Ineffective Breathing Pattern related to shortness of
breath, mucus, bronchoconstriction and airway
irritants.
3. Activity Intolerance related to imbalance between
supply with oxygen demand.
4. Imbalanced Nutrition: Less than Body Requirements
related to anorexia.
5. Disturbed Sleep Pattern related to discomfort, the
setting position.

36. NURSING INERVENTION
 Assess and record respiratory rate, depth. Note use of
accessory muscles, pursed-lip breathing, inability to
speak or converse.
 Encourage expectoration of sputum; suction when
indicated.
 Monitor vital signs and cardiac rhythm.
 Assess and monitor respirations and breath sounds,
noting rate and sounds (tachypnea, wheezes)
 Demonstrate effective coughing and deep-breathing
techniques.
 Administer bronchodilators if prescribed.

37. HEALTH EDUCATION
 Take your quick-relief inhaler when you feel short of
breath and need help fast.
 Take your long-term drug every day.
 Stay away from smokers when you are out, and do not
allow smoking in your home.
 Stay away from strong odours and fumes.
 Do breathing exercise.
Call your doctor if your breathing is:
 Getting harder
 Faster than before
 Shallow, and you cannot get a deep breath