COPD, which includes chronic bronchitis and emphysema, is a progressive lung disease caused by smoking and pollution that damages the lungs over time. Management of COPD focuses on bronchodilators to open the airways, oxygen therapy when oxygen levels are low, chest physiotherapy to clear mucus, and lifestyle changes like quitting smoking. Emphysema specifically causes damage to the alveoli that lose their ability to recoil, leading to air trapping and hyperinflation of the lungs visible as barrel chest. Proper management can help control symptoms but COPD is currently incurable.
COPD, which includes chronic bronchitis and emphysema, is a progressive lung disease caused by smoking and pollution that damages the lungs over time. Management of COPD focuses on bronchodilators to open the airways, oxygen therapy when oxygen levels are low, chest physiotherapy to clear mucus, and lifestyle changes like quitting smoking. Emphysema specifically causes damage to the alveoli that lose their ability to recoil, leading to air trapping and hyperinflation of the lungs visible as barrel chest. Proper management can help control symptoms but COPD is currently incurable.
COPD, which includes chronic bronchitis and emphysema, is a progressive lung disease caused by smoking and pollution that damages the lungs over time. Management of COPD focuses on bronchodilators to open the airways, oxygen therapy when oxygen levels are low, chest physiotherapy to clear mucus, and lifestyle changes like quitting smoking. Emphysema specifically causes damage to the alveoli that lose their ability to recoil, leading to air trapping and hyperinflation of the lungs visible as barrel chest. Proper management can help control symptoms but COPD is currently incurable.
COPD, which includes chronic bronchitis and emphysema, is a progressive lung disease caused by smoking and pollution that damages the lungs over time. Management of COPD focuses on bronchodilators to open the airways, oxygen therapy when oxygen levels are low, chest physiotherapy to clear mucus, and lifestyle changes like quitting smoking. Emphysema specifically causes damage to the alveoli that lose their ability to recoil, leading to air trapping and hyperinflation of the lungs visible as barrel chest. Proper management can help control symptoms but COPD is currently incurable.
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DISORDERS OF THE RESPIRATORY SYSTEM BRONCHODILATORS ARE GIVEN FIRST THAN OXYGEN
PART A – COPD BECAUSE WE NEED TO DILATE THE LUNGS FIRST SO
THAT THE OXYGEN CAN ENTER PROPERLY A.) COPD (Chronic Obstructive Pulmonary Disorder) - MANAGEMENT: (ABCD) Aka CAL – Chronic Airway Limitation A – Airway O2 needed (Low flow; 2- “Chronic” 3L/min) - > 6months; progressive B – Bronchodilators “Obstruction” Types: - Bronchoconstriction 1) XANTHINE DERIVATIVES (-PHYLLINE) “Pulmonary” – MOA: relaxes the smooth muscle - Referring to lungs of the bronchioles COPD – there is inflammation (vasodilation), – ‘Caffeine’ containing therefore there’s tissue injury – CI coffee TISSUE INJURY Arachydonic Acid becomes – S/E: Palpitations Leukotriene by means of lipoxygenase; Leukotriene – Example: Aminophylline; causes bronchoconstriction Theophylline ----Arachydonic acid by means of COX-2 Agonist – promoter (cyclooxygenase)becomes prostaglandin causes Antagonist – Pain. blocker/inhibitor a) CHRONIC BRONCHITIS B1 – Heart (increase HR) - Aka “blue bloaters” B2 – Lungs (bronchodilation) - Definition: productive cough (mucus) for 3 2) B2 AGONIST months in 2 consecutive years (thus, total 6 – Example: ventolin months) – No Specificity (meaning it affects - Causes: ALL beta-receptors!!) 1. Smoking (main cause) – S/E: Tachycardia 2. Environmental Pollutants 3) LEUKOTRIENE ANTAGONIST - PATHOPHYSIOLOGY – Example: Zafirkulast SMOKING 4) ANTICHOLINERGIC BRONCHODILATOR Irritation of the Respiratory tract – Example: Ipratopium Inflammation C – Chest Physiotherapy 1. Bronchoconstriction S (1) Mucus (2) Able DOB due to a decrease in O2 When? (1) Upon awakening (2) Morning Diaphragm will push the lungs Use of *Location? best way to locate CXR accessory muscles (diaphragm) Fatigue Common way Ausculation less appetite Anorexia WEIGHT *Effective? If there is clear breath sounds, LOSS it is effective 2. Hypertrophy of Goblet Cells (produces *AUSCULTATE WHEN? mucus) Before – YES (TO KNOW Increase of mucus secretion therefore LOCATION) productive cough During – NO Cyanosis can occur due to a decrease in O2 After - YES PHASES OF CHEST PHYSIOTHERAPY: **NOTE: A.) Percussion: - Aka clapping - Hands: cupped - When? Exhalation - Cx: breast, liver, abdomen, kidney, heart B.) Vibration: - FLAT hands - Performed during EXHALATION as well C.) Postural Drainage: - Aka bronchial segment drainage - Position + Gravity - Duration: 30 mins - Secretions in higher lobe HIGH E – exhalation, ERV – expiratory reserve volume, RV – FOWLER’S residual volume (needed to prevent lung collapse) - Secretions in lower lobe **NOT EVERYTHING IS EXPELLED THEREFORE, THE TRENDELENBURG (using gravity to ALVEOLI CONTINUES TO EXPAND, IT PUSHES THE make secretions go to the upper WHOLE THORAX, THIS CAUSES THE PATIENT TO lobe DEVELOP “BARREL CHEST” D – Drugs - Due to Hyperinflation, it is possible for the 1) MUCOLYTIC alveoli to RUPTURE. *MOA: liquefies mucus to make them - Alveoli is VASCULAR meaning it contains soft blood, so what happens when alveoli *Example: Carbocisteine hyper-inflates, it can rupture. 2) EXPECTORANT - Therefore when the patient coughs, there *MOA: to cough out secretions will be blood (HEMOPTYSIS, LATE SIGN) => *Example: Guiatenesin MABULA/BUBBLY SALIVA w blood => b) EMPHYSEMA FROTHY SPUTUM (CO2 IS IN SALIVA) - Pink Puffers - S/SX: - Definition: overdistention/hyperinflation 1. NO COUGH is present of the alveoli 2. Barrel Chest - Cause: Smoking 10k packs of cigarettes 3. Hyper-resonance determined consumed (1pack =20 sticks) during PERCUSSION - NORMAL PHYSIOLOGY: 4. Increase in RESIDUAL VOLUME INHALE IN O2 Lungs expands 5. Orthopnea is present (DO NOT Lungs recoils alpha 1- EXHAL CONFUSE WITH ORTHOPNEIC OUT CO2 antitrypsin is responsible for E POSITION) the recoiling. -Orthopneic position -> management - PROBLEM alpha 1 antitrypsin is by nurse decreased decrease in recoil CO2 is -Orthopnea -> symptom, the pt can retained breathe only when leaning forward - PATHOPHYSIOLOGY 6. Hemoptysis (LATE SIGN) Smoking Decrease in alpha 1 antitrypsin - MANAGEMENT: Decrease in recoiling Air trapping 1) Avoid smoking CO2 retentionHyperinflation of ALVEOLI 2) DIET: BARREL CHEST *decrease carbohydrates because they will increase CO2 if consumed) *increase CHON (muscles build) *increase calories (for energy) *Prostaglandin minor hormone 3) Purse Lip Breathing (found in stomach & kidneys) *Inhale NOSE NO PROSTAGLANDIN NO PAIN. *Exhale MOUTH (gradually to make *You should take steroids AFTER A sure that the air doesn’t bounce back MEAL ONLY and cause atelactasis!!!) *Route metered dose inhaler c) BRONCHIAL ASTHMA (1.3shake, 1-3 buga, 1-10 buga) - Not curable *S/E: (1) water retention, (2) - Treatable/manageable decreases immune system, (3) - Definition: irreversible lung condition candidiasis ORAL CARE NEEDED caused by hypersensitivity leading to TO PREVENT THIS!! smaller airways. 2) OXYGEN AFTER - Types: 3) BROWN PAPER BAG DURING 1) INTRINSIC ASTHMA MEDULLA OBLONGATA stimulated by CO2 *aka primary asthma O2 & CO2 INVERSELY PROPORTIONAL!! *non-allergic asthma Medulla oblongata wants decrease in oxygen and *Meds: Aspirin, Penicillin increase in CO2 *Due to change in temperature, stress - WOF: Status Asthmaticus (life-threatening 2) EXTRINSIC ASTHMA type of asthma!! complete obstruction); *secondary asthma sign of this is NO MORE WHEEZING *Allergic asthma (dust, pollen grains, SOUNDS perfume) d) BRONCHIECTASIS 3) COMBINATION/MIXED TYPE OF - Definition: permanent dilation of the ASTHMA bronchioles due to recurrent respiratory - PATHOPHYSIOLOGY: infection. Antigen vs Antibody if you are exposed - Cause: to foreign antigens, it will cause 1. Respiratory Infection (most common) inflammation severe 2. Tumor bronchoconstriction wheezing DOB - PATHOPHYSIOLOGY: use accessory muscles fatigue RESPIRATORY INFECTION inflammation anorexia weight loss of bronchioles (bronchoconstriction) - MANAGEMENT hypertrophy of goblet cells increase in 1) MEDICATIONS (because affects on mucus secretion PUS formation bronchioles) HALITOSIS a. Mucolytics *DILATION LATE STAGE, happens b. Expectorants because eof recurrent infections c. Bronchodilators - S/Sx: d. Steroids 1. Pus: Sputum *anti-inflammatory; hence 2. Fever bronchoconstriction! 3. Halitosis *MOA: blocks COX and 4. Productive Cough arachydonic acid (so - MANAGEMENT: prostaglandins and leukotriene 1) INCREASE ORAL FLUID INTAKE (to won’t be produced) liquefy mucus secretions) 2) MEDICATIONS: *Mucolytics *Expectorants *Bronchodilator (ONLY IF ITS STILL CONTRICTED) *Antibiotics (BECAUSE THERE IS INFECTION) 3) CHEST PHYSIOTHERAPY 4) STEAM INHALATION (SUOB) *to administer medications *liquefy mucus *relaxes smooth muscles (bronchioles) *FUNCTION: DEPENDENT *CX: BURNS *SHIELD: towel on chest to prevent burns *DISTANCE: 12-18 inches *DURATION: 30 mins
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