In: Nursing
a. Chronic Obstructive Pulmonary Disease(COPD)
Chronic obstructive pulmonary disease (COPD) is a disease state characterised by air flow limitation that is not fully reversible. COPD may include disease that cause airflow obstruction(eg.emphysema, chronic bronchitis) or a combination of these disorders.
Medical management
* Smoking sessation is the single most effective intervention to prevent COPD or slow it's progression.
Medications
1.Bronchodilators
Bronchodilators relieve bronchospasm and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving aleveolar ventilation. These medications,Which are central in the management of COPD are delivered through a Metered dose inhaler(MDI) by nebulization, or via the oral route in pill or liquid form. MDI is a pressurized device containing an aerosolized powder of medication.
Three major classes of bronchodilators
* Beta 2 agonists
Short acting: salbutamol and terbutaline
Long acting: salmeterol and formoterol
* Anticholinergic agents:
Ipratropium and Tiotropium
* Theophylline
A weak bronchodilator, which may have some anti inflammatory properties.
2.Glucocorticoids
Regular treatment with inhaled glucocorticoids is appropriate for symptomatic patients with an FEV1<50% pred and repeated exacerbations. Chronic treatment with systemic glucocorticoids should be avoided because of an unfavourable benefit to risk ratio.
3.Combination therapy
Combination therapy of long acting Beta 2 agonist and inhaled corticosteroids show a significant additional effect on pulmonary function and a reduction in symptoms.Mainly in patients with an FEN1<pred.
4.Others
Influenza vaccines can reduce serious illness polysaccharide vaccine is recommended for COPD patients 65 years and older and forCOPD patients younger than age 65 with an FEV1<40%pred. The use of antibiotics other than for treating infectious exacerbations of COPD and other bacterial infections is currently not indicated.
Nursing Management
* Assess the client status ask detail about smoking (pack per year history),occupational exposure history,positive family history of respiratory disease etc.
* If the patient have a smoking history then the nurse should teach the ways for smoking cessation.
*Note amount ,colour and consistency of sputum.
* The nurse should be inspect for use of accessory muscles during respiration and use of abdominal muscles during expiration.
* The nurse plays a key role in identifying potential candidates for or pulmonary rehabilitation and in facilitating and reinforcing the material learned in the the rehabilitation program
*The nurse should teach to patient and family as well as facilitating specific services for the patient(example respiratory therapy education ,physical therapy for exercise and breathing retraining,occupational therapy medications using example MDI, nebulization for conserving energy during activities of daily living and nutritional counseling)
b. Lung Cancer
Lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung.If left untreated this growth can spread beyond the lung by the process of metastasis into nearby tissues or other parts of the body.
Medications
1.Chemotherapy
For lung cancer chemotherapy is treated with anticancer drugs injected into vein or taken by mouth these drugs enter into the bloodstream and go throughout the body making the treatment useful for cancer anywhere in the body. Drugs used for chemotherapy are as follows:
* Cisplatin
* Carboplatin
* Paclitaxel(taxol)
* Albumin-b
* Docetaxel(taxotere)
* Vonirelbine(navelbine)
* Vinvlastine
Side effects of these medications are hair loss, mouth sores,loss of appetite, nausea and vomiting, diarrhoea or constipation easy bruising or bleeding and fatigue.
Nursing Management
* Monitor signs and symptoms of respiratory failure
* Administer chemotherapy and other decide medications
* Educate patient with their disease and its progression.
* Provide psychological support to the patient to reduce the anxiety level of the patient.
* Monitor the respiratory status of the patient.
* Lab investigations and other diagnostic tests.
* Educate the patient about disease condition, diagnosis treatment and its side effects.
c. Pneumonia
Pneumonia is an infection in one or both lungs.It causes inflammation in the alveoli and they are filled with fluid or pus making it difficult to breathe.
Medications
1.For out patients
Previously healthy and no antibiotics in past 3 months
* A microlide(clarithromycin or Azithromycin or Doxycycline
Comorobidities for antibiotics in past 3 months:
* Respiratory fluoro quinolone (moxifloxacin ,levofloxacin) Or beta lactam (high dose Amoxicillin or amoxicillin/clavulanate)
2. For inpatients, Non ICU
Respiratory floroquinolone moxifloxacin levofloxacin beta-lactam (cefotaxime ,ceftriaxone ,ampicillin) plus a macrolide (oral Clarethroromycin or azithromycin)
3. For inpatient, ICU
Beta -lactam plus Azithromycin or fluoroquinolone.
Nursing Management
*Assess rate, depth of respirations and chest movement.
* Auscultate lung fields .
* Elevate head of body .
* Assist and demonstrate client with frequent deep-breathing exercises, splinting the chest and coughing .
* Suction is done as indicated .
* Force fluid to atleast 2500 ml per day, unless contraindicated ,as in HF.
* assess the respiratory status skin colour, mental status, hearth rhythm and body temperature.
* Elevate head and encourage frequent position changes, deep breathing, and effective coughing.And maintain bed rest.
* Observe for the deorientation in condition, noting hypertension ,copious amounts of pink or blood sputum ,Pallor,cyanosis ,change in level of consciousness, severe dyspnea and restlessness.
* Monitor ABG s and Pulse oximetry.
* Administrator oxygen therapy by appropriate.
* Monitor vital signs closely, especially during initiation of therapy.
* Instruct client concerning the disposition of secretions reporting changes in colour, amount, and ordour of secretions.
* Change position frequently and provide good permanently toilet.
* Perform proper suctioning technique for ventilated clients as appropriate.
* Limit visitors, and institute isolation precautions as individually appropriate.