- Clinical Manifestations: chronic cough, sputum production, DOE, and progressive; weight loss.
- Medical Management: smoke cessation, bronchodilators/corticosteroids
- Nursing Assessment: determine current symptoms.
- Nursing Management:
- Achieving Airway Clearance: Monitor for dyspnea and hypoxemia, pharmacologic therapy, measure expiratory flow rates and volumes; postural drainage, chest physiotherapy
- Improving Activity Tolerance
- Improve Breathing Patterns
- Monitor for Complications’
Emphysema
Abnormal distention of the airspaces → destruction of the walls of the alveoli. Due to its resultant appearance, it is termed as the “Pink Puffer” disease.
- Clinical Manifestations: barrel chest, severe dyspnea, thin-framed body
- Diagnostics: incentive spirometry, CXR, hyperinflation + flattened diaphragm, arterial blood gases (mild-mod hypoxemia, respiratory acidosis)
Chronic Bronchitis
The presence of cough and sputum daily for at least 3 months in at least two consecutive years. Inflammation and sputum production results in increased mucus-secreting cells, and further increases mucus production. Blockage of the airways reduces ciliary function. Due to its resultant appearance, it is termed as the “Blue Bloater” disease.
- Clinical Manifestations: chronic productive cough, weight gain, elevated hemoglobin (compensatory), wheezing, peripheral edema
- Diagnostics: incentive spirometry, arterial blood gases (mild-mod hypoxia, respiratory acidosis), at least 3 months of daily chronic coughing in two consecutive years.
- Complications: RSHF, Pneumonia, Pneumothorax
Emphysema and Chronic Bronchitis
- Nursing Management: low flow oxygen (2-3 L/min) via a Venturi mask; semi-/high-fowler’s position; teaching pursed-lip breathing; chest physiotherapy
- Pharmacologic Management: bronchodilators (beta-2 agonists, anticholinergics), steroids, methylxanthines
- Dietary Management: high calorie, high protein diet