CASTAEDA, Bettina Kaye D.

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N124 Activity 2 List 4 protective mechanisms of the respiratory system. - Coughing and Sneezing - Cilia on the nasal cavity - Mucus Production - Macrophages and lymphocytes in the Mucosa What is the best physical assessment guide in the anterior chest to accurately number the ribs in order to locate a finding? - Palpation and Percussion Uncompensated Respiratory Alkalosis 3 Principles involved in Postural Drainage - Chest Percussion This can help in the effective dislodgement of the secretions in the underlying bronchus as the compression wave is presumably transmitted to the underlying bronchus and gravitational aid causes flow of secretions from the bronchus towards the glottis. (US NIH, 2012) - Vibration Rapid vibratory impulse is transmitted through the chest wall from the flattened hands of the therapist by isometric alternate contraction of forearm flexor and extensor muscles, to loosen and dislodge the airway secretions. (US NIH, 2012) - Coughing Stimulation and Thoracic Squeezing This is done to release sputum accumulation and enhancing expiration. Interventions for: a. Adequate Ventilation - Suction as needed - Maintain cuff inflated appropriately - Maintain mechanical ventilator settings - Check ET placement and level b. Ability to Communicate - Establish mode of communication with patient if conscious - Monitor patient LOC and VS - Monitor Mechanical Ventilator settings - Monitor for alarms and troubleshoot Intubation: - Oxygen Flowmeter and O2 Tubing - Suction Apparatus and Catheter - Bag Valve Mask and Mask - Laryngoscope with appropriate blade - ET Tube with functional bulb - Stylet - Anesthetic - Stethoscope - Syringe - Tape and ET Tie COPD a. Affected Physiologic Functions

- The airways and air sacs lose their elastic quality - The walls between many of the air sacs are destroyed - The walls of the airways become thick and inflamed - The airways make more mucus than usual, which can clog them Thus, the intake of oxygen and the delivery of oxygen throughout the body are impaired. b. Signs and Symptoms - Breathlessness - Chronic Cough - Chest tightness - Wheezing c. Pathophysiology In COPD, smoking and other airway irritants cause neutrophils, T-lymphocytes, and other inflammatory cells to accumulate in the airways. They trigger an inflammatory response in which an influx of the inflammatory mediators goes to the site in an attempt to destroy and remove inhaled foreign debris. Normally, the inflammatory response is useful and leads to healing. But in COPD, repeated exposure to airway irritants perpetuates an ongoing inflammatory response and it does not end. Over time, this process causes structural and physiological lung changes that get progressively worse. As inflammation continues, the airways constrict, becoming excessively narrow and swollen. This leads to excess mucus production and poorly functioning cilia, a combination that makes airway clearance especially difficult. Thus, an impaired oxygen intake and transport leads to the ineffective perfusion of other body organs and parts. Also, because of the airway obstruction there is an alveolar hypoxia which leads to alveolar damage which can contribute to the decrease in lung compliance therefore signaling a perfusion-ventilation mismatch which leads to impaired gas exchanges. When people with COPD can't clear their secretions, they develop the hallmark symptoms of COPD, including a chronic, productive cough, wheezing and dyspnea. Finally, the build-up of mucus attracts a host of bacteria that thrive and multiply in the warm, moist environment of the airway and lungs. The end result is further inflammation, the formation of in the bronchial tree, and bacterial lung infection, a common cause of COPD exacerbation. (Urden, Stacy & Lough, 2006) d. Nursing Interventions - Administer prescribed medications, which may include antibiotics, broncodilators, mucolytic agents and corticosteroids. Antibiotics should be administered at the first sign of infection, such as change in sputum. Opioids, sedatives and tranquilizers, which can further depress respirations, should be avoided. - Use an inhaler and take medications as prescribed, and notify the health care provider when not gaining complete relief. - Clear airways with postural drainage, percussion or vibrating and suctioning as appropriate. - Promote infection control. - Demonstrate and encourage diaphragmatic and purse lip breathing. - Administer oxygen as needed.
REFERENCES Brunner, L. S., Suddarth, D. S., &Smeltzer, S. C. O. (2008). Brunner &Suddarth's textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins. Papadaki, H. & Velegraki, M. (2007). The Immunology of the Respiratory System. Retrieved from: http://www.mednet.gr/pneumon/pdf/20-4-6e.pdf on September 11, 2013. Urden, L., Stacy, K. & Lough, M. (2006).Thelans Critical Care Nursing Diagnosis & Management (5th ed.). St. Louis: Mosby. US NIH. (2013). Chronic Obstructive Pulmonary Disease. Retrieved from: http://www.nhlbi.nih.gov/ health/health-topics/topics/copd/ on September 11, 2013. WHO. (2012). Chronic Obstructive Pulmonary Disease. Retrieved from: http://www.who.int/ mediacentre/factsheets/fs315/en/ on September 11, 2013.