NCLEX-RN Exam Cram: Caring for the Client with Disorders of the Respiratory System
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) exists when prolonged disease or injury has made the lungs less capable of meeting the body’s oxygen needs. Examples of COPD include chronic bronchitis, emphysema, and asthma.
Chronic bronchitis, an inflammation of the bronchi and bronchioles, is caused by continuous exposure to infection and non-infectious irritants, such as cigarette smoke. The condition is most common in those ages 40 to 55. Chronic bronchitis may be reversed with the removal of noxious irritants, although it is often complicated by chronic lung infections. These infections, which are characterized by a productive cough and dyspnea, can progress to right-sided heart failure and pulmonary hypertension. Chronic bronchitis and emphysema have similar symptoms that require similar interventions.
Emphysema is the irreversible overdistention of the airspaces of the lungs, which results in destruction of the alveolar walls. Clients with emphysema are classified as pink puffers or blue bloaters. Pink puffers may complain of exertional dyspnea without cyanosis. Blue bloaters develop chronic hypoxia, cyanosis, polycythemia, cor pulmonale, pulmonary edema, and eventually respiratory failure.
Physical assessment reveals the presence of a barrel chest, use of accessory muscles, coughing with the production of thick mucoid sputum, prolonged expiratory phase with grunting respirations, peripheral cyanosis, and digital clubbing.
In identifying emphysema, a chest x-ray reveals hyperinflation of the lungs with flattened diaphragm. Pulmonary studies show that the residual volume is increased while vital capacity is decreased. Arterial blood gases reveal hypoxemia.
Many symptoms of chronic bronchitis and emphysema are the same; therefore, medications for the client with chronic bronchitis and emphysema include bronchodilators, steroids, antibiotics, and expectorants. Oxygen should be administered via nasal cannula at 2–3 liters/minute. Close attention should be given to correcting acid-base imbalances, meeting the client’s nutritional needs, avoidance of respiratory irritants, prevention of respiratory infections, providing oral hygiene, and client teaching regarding medications.
Asthma is the most common respiratory condition of childhood. Intrinsic (nonallergenic) asthma is precipitated by exposure to cold temperatures or infection. Extrinsic (allergenic or atopic) asthma is often associated with childhood eczema. Both asthma and eczema are triggered by allergies to certain foods or food additives. Introducing new foods to the infant one at a time helps decrease the development of these allergic responses. Easily digested, hypoallergenic foods and juices should be introduced first, including rice cereal and apple juice, which may be given at six months of age. Cow’s milk should not be given to the infant before one year of age. Symptoms of asthma include expiratory wheeze; shortness of breath; and a dry, hacking cough, which eventually produces thick, white, tenacious sputum. In some instances an attack may progress to status asthmaticus, leading to respiratory collapse and death.
Management of the client with asthma includes maintenance therapy with mast cell stabilizers and leukotriene modifiers. Treatment of acute asthmatic attacks includes the administration of oral or inhaled short-term or long-term B2 agonist and anti-inflammatories as well as supplemental oxygen. Methylxanthines, such as aminophylline, are rarely used for the treatment of asthma. These drugs, which can cause tachycardia and dysrhythmias, are administered as a last resort. Antibiotics are frequently ordered when a respiratory infection is present.