DQ 4 Replies 641e
Tischara Walther
Re:Topic 4 DQ 1
“The main cause of COPD is smoking. Breathing in smoke and chemicals can injure the airways and air sacs” (Roland, 2016, para 7). “Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD” (Mayo Clinic Staff, 2016, para 2). Damaged alveoli at the end of bronchioles make it difficult to breath and for oxygen to transfer. There other issue that contributes to the diagnosis of COPD is Bronchitis. “In chronic bronchitis, the lining of the airways is constantly irritated and inflamed. This causes the lining to thicken” (NIH, 2013, para 11).
Pneumococcal pneumonia is caused by bacteria. “Pneumonia can be caused by a variety of viruses, bacteria, and sometimes fungi. Pneumococcal pneumonia is caused by bacteria called Streptococcus pneumoniae or strep. S. pneumoniae is also called pneumococcus” (MedicineNet.com, 2016, para 3). Pneumonia is an illness caused by a virus or bacteria. It often times can cause breathing issues as and interference with oxygen flow can be apparent. “Complications of pneumococcal pneumonia include infection of the space between membranes that surround the lungs and chest cavity (empyema), inflammation of the sac surrounding the heart (pericarditis), and blockage of the airway that allows air into the lungs (endobronchial obstruction), with lung collapse (atelectasis) and collection of pus (abscess) in the lungs” (CDC, 2015, para 9).
Both can affect the alveoli and airway obstruction. Most obviously is the fact that one is hopefully treatable and one is not. COPD is diagnosed based off of symptoms and how often they occur, but pneumonia can be diagnosed by blood work, sputum, xray, and health assessments. In both cases the narrowing of bronchioles and branches within the lungs can cause mucous build up.
Teaching for both patient dealing with these issues can be very similar. You would want to encourage both of them to stop smoking and stay away from other irritants. Encourage both patients to come to the ER to be seen if ability to breath decreases or becomes more rapid. Inhaler use should also be discussed. With COPD the rescue inhaler should be identified differently than the maintenance inhaler. Pet hair in the home should be kept cleaned up. Handwashing with pneumonia should be discussed and enforced. Pneumonia vaccine should also be given if permission for both patients as risks are higher once having pneumonia and also with the COPD symptoms.
Reference
Centers of Disease Control. 2015. Pneumococcal disease. Retrieved from https://www.cdc.gov/pneumococcal/about/symptoms-complications.html
Mayo clinic staff. 2016. COPD. Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/copd/home/ovc-20204882
National heart blood and blood institute. 2013. What is COPD. Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/copd
Roland, J. 2016. What is the pathophysiology of COPD? Healthline. Retrieved from http://www.healthline.com/health/copd/pathophysiology#Overview1
Nancy Hege
Re:Topic 4 DQ 1
COPD is a preventable disease in most cases, the primary cause is smoking. It is treatable but not reversible, it is a chronic, progressive disorder characterized by restricted airflow and inflammation. COPD results from two different processes, chronic bronchitis and emphysema.
Chronic bronchitis is hypersecretion of mucus and a chronic productive cough. When a person with chronic bronchitis smokes tobacco this results in airway inflammation. Neutrophils, macrophages and lymphocytes infiltrate the bronchial wall. The continual bronchial inflammation, from smoking, causes bronchial edema and the size and number of goblet sells are increased, so more mucous is secreted. Eventually all airways are involved. The hypertrophied bronchial smooth muscle narrow the airways and lead to obstruction during expiration. Gas is trapped in the distal portion of the lung. Symptoms are shortness of breath, decreased exercise tolerance, wheezing, and a productive cough. Education from the nurse should include of course the recommendation to stop smoking, nutritional counseling, signs and symptoms of respiratory infection, pursed lip breathing techniques. Because the patients peripheral chemoreceptors stimulate breathing instead of the central chemoreceptors, the patients have hypoxic drive. Oxygen
should be administered low doses because the peripheral chemoreceptors will not respond to PaO2 levels over 60mmHg. High doses of oxygen can lead to apnea.
Emphysema, also caused by tobacco smoking, is an enlargement of airspace within the bronchioles and alveoli brought on by the breakdown of walls in the air spaces. An imbalance of proteases and antiproteases, oxidative stress, and apoptosis of lung cells leads to the breakdown of elastin within the septa. There is a reduction in the area for gas exchange due to the destruction of alveoli. Expiration is impaired because of the loss of elastic recoil and air is trapped in the lungs. This air trapping causes hyperexpansion of the chest (barrel chest). Constant inflammation in the airways can result in bronchoconstriction. These patients have a nonproductive cough, shortness of breath on exertion, tachypnea, and use accessory muscles for breathing. Again caution should be used when administering oxygen therapy due to the hypoxic drive. The patient should be taught pursed lip breathing techniques, to recognize early signs of respiratory infection, proper nutrition and also to stop smoking.
Pneumococcal pneumonia is a bacterial pneumonia, the bacteria is streptococcus pneumoniae. S. pneumoniae triggers an immune response that includes complement activation andthe production of antibodies which encapsulate the bacteria. When a patient is treated with antibiotics, this can lead to a rapid lysis of pneumococcal bacteria, which can release the intracellular bacteria, which can be toxic to every cell of the lung and possibly worsen the condition. Inflammatory cytokines are released and can cause alveolar edema. The edema can spread the infection to other portions of the lung. The alveoli then fill with blood cells, fibrin, edematous fluid, and pneumococci. The next step in the disease process is when fibrin and neutrophils are present in the alveoli, and phagocytosis takes place. Finally macrophages are present and digest the fibrin and bacteria. Patient teaching should include the information that the pneumonia may worsen after antibiotics are started.
Burchum, J., Rosenthal, L.(2016) Lehne’s pharmacology for nursing.(9th ed). St. Louis, MO, Elsevier Saunders
McCance, K., Huether, S. Brashers, V., Rote, N. (2016) Pathophysiology, The biologic basis for disease in adults and children (7thed). St. Louis. MO, Elsevier Mosby
Tischara Walther
Re:Topic 4 DQ 2
An increase in life expectancy was the driving factor behind this 2016 study. Cystic Fibrosis is a progressive, autosomal, recessive hereditary disease that affects the white population. “Data from a United States registry of adult CF patients show that the mean predicted survival in CF is currently 38.3 y of age and 43% of individuals with CF are age 18 y or older” (Flores, 2016, p. 192). Lung disease is the cause of death in most cases. Lung disease can be measured by FEV1. “Forced expiratory volume (FEV) measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1)” (WebMD, 2015, para 1).
40 participants from a previous study 10 years ago participated in this cross study. Detailed testing was performed equally to each study participant. By 2012 32 participants were still alive without a lung transplant. Four of those who died was caused by lung disease. 27 of them were now agree to participate. The seven year follow up showed that the FEV was a reliable source of poor outcome predictors. It also showed that the 32 left were showing a severe decline in testing. There were several limitations, but the smaller size appeared to have more accurate results.
I chose this article because I wanted to see what the pattern of decline was for those dealing with CF if there was one at all. This interestingly did show a slight patter among non-transplanted CF patients. Although these participants were tested in Brazil it can give me an ideal of what tests are important to share with patients while caring for them as a nurse. When terms such as FEV are used, I now will be able to understand what the term stands for. I also can educate a patient as to test they could inquire about. It was also nice to see in several articles that the average age of CF survival is increasing with care and management.
Reference
Silva Flores, J., Eidt Rovedder, P. M., Ziegler, B., Furlan Pinotti, A. F., Saldanha Menna Barreto, S., & de Tarso Roth Dalcin, P. (2016). Clinical Outcomes and Prognostic Factors in a Cohort of Adults With Cystic Fibrosis: A 7-Year Follow-Up Study. Respiratory Care, 61(2), 192-199. doi:10.4187/respcare.04097
WebMD. 2015. Lung disease & respiratory health center. Retrieved from http://www.webmd.com/lung/tc/forced-expiratory-volume-and-forced-vital-capacity-topic-overview