N211: Health Differences Across the Lifespan I ventilation, smoking cessation, and avoidance of people with respiratory infections. Client may require intermittent positive pressure breathing (IPPB), possible mechanical ventilation and possible surgical procedures such as lung volume reduction surgery or lung transplantation. Asthma is a chronic reactive airway disease. Bronchial linings overreact to various intrinsic and extrinsic stimuli, causing episodic spasms and inflammation that can severely restrict the airways. There is a narrowing or closure of the airway due to a variety of stimulants. Precipitating factors include mucosal edema, beta blockers, respiratory infection, allergic reaction, emotional stress, exercise, reflux esophagitis and environmental or occupational exposure. Nursing Assessments Includes chest tightness, dyspnea, wheezing, primarily on expiration, tachypnea, tachycardia, and use of accessory muscles. Nursing Interventions Are to increase fluid intake to prevent thickened secretions, beta-adrenergic drugs (Serevent), bronchodilators (Albuterol, Ipratropium bromide), and mast cell stabilizer (Intal). Administer fluids and humidification. Monitor ABGs and ventilator patterns. Compensation occurs over time in clients with chronic lung disease and altered ABGs. As COPD worsens, the amount of oxygen in the blood decreased and the amount of carbon dioxide in the blood increases causing chronic respiratory acidosis, which results in metabolic alkalosis as compensation. Not all clients with COPD are carbon dioxide retainers, even when hypoxemia is present, because carbon dioxide diffuses more easily across lung membranes than oxygen. With advanced emphysema, the alveoli are affected, and hypercarbia is a problem, rather than bronchitis, where the airways are affected. Productive cough and comfort can be facilitated by client in the semi-fowlers or high fowler’s position, which lessens pressure on the diaphragm by the abdominal organs. Gastric distention becomes a priority in clients because it elevates the diaphragm and full lung expansion. The pink puffer is barrel chested which is indicative of emphysema and is caused by use of the accessory muscles to breath. The person works harder to breathe, but the amount of oxygen taken in is inadequate to oxygenate. The blue bloater has insufficient oxygenation with chronic bronchitis, and this leads to cyanosis and often right sided heart failure (cor pulmonale). Cells of the body depend on oxygen to carry out their functions. Inadequate arterial oxygenation is manifested by cyanosis and capillary refill (<3 seconds). A chronic sign of clubbing of the fingernails and a later sign is clubbing of the fingers.
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