idiopathic pulmonary fibrosis causes
- older w hx of smoking, chronic exposure to inhaled irritants, drugs amiodarone (Cordarone) or ambrisentan
- excessive wound healing w loss of cellular regulation-honeycomb
idopathic pulmonary fibrosis treatment
- focus on slowing fibrotic process and control dyspnea
- corticosteroids and immunosuppressants
- cyclophosphamide (Cytoxan, Neosar), azithioprine (Imuran), chlorambucil (Leukeran), methotrexate (Folex)
- oxygen and morphine
IV infusion of prostacyclin therapy
- specific dilation of pulmonary arteries
- continuous, dedicated line, don’t flush, right brand, use pt
- epoprostenol (Flolan, Veletri), trepostinil (Remodulin)
Sarcoidosis information
- cough, dyspnea, and abnormal abdominal chest xray but otherwise asymptomatic
- rule out infection/cancer
- staged based on xray findings
- can lead to pulmonary htn
sarcoidosis pt care
- focus to reduce manifestations and prevent fibrosis
- no symptoms-no tx
- corticosteroids
- assess symptom severity, pulm funct studies, chest xray, cbc, cr, ca, urinalysis
- educate steroid side effects, avoid infection, energy conservation
sarcoidosis indicators for tx-5
decreased total lung capacity, diffusing capacity, or forced vital capacity, involvement of other organs, hypercalcemia
paraneoplastic syndrome-5
- hormones secreted by tumor cells
1. adrenocorticotropic hormone (ACTH)- Cushing’s syndrome
2. antidiuretic hormone- syndrome of inappropriate antidiuretic hormone (SIADH), weight gain, general edema, dilution of serum electrolytes
3. follicule stimulating hormone (FSH)- gynocomastia
4. parathyroid hormone- hypercalcemia
5. ectopic insulin- hypoglycemia
warning signs of lung cancer
- hoarseness, change in resp pattern/ cough/wheeze/dyspnea, sputum-blood/rust/purulent
- pain-chest/shoulder/arm
- recurring episodes of pleural effusion, pneumonia, bronchitis
- fever, wt loss, clubbing
nicotine replacement risks
smokinh while on nicotine can put to much in system and lead to stroke or heart attack
tobacco screening
- past or current
- how many a day, duration, age when started
- pack years (ppd x years)
- secondhand and thirdhand smoke, social smoker
- hooka, waterpipe, ecig
impaired gas exchange
takes place in lung tissue between alveoli and capillaries, not the airways
-right bronchus- bad intubation and foreign objects
aging changes in resp-alveoli
decrease-surface area, diffusion, elastic recoil, ability to cough
-encourage turn, cough, deep breathe, incentive spirometry, upright position
aging changes in resp-lungs
- residual vol increases, vital cap, O2 and CO2 exchange, elasticity decrease
- include inspection, palpation, percussion, and auscultation, abnormal breathing patterns in assessment, encourage activity and frequent oral hygiene
aging changes in resp- pharynx and larynx
muscle, vocal cords, cartilage atrophy
-face to face convo
aging changes in resp-pulmonary vasculature
assess LOC and cognition
capnography readings- increase
- amt of CO@ in exhaled air
- normal 20-40
- detect hypoxia before pulse oximetry
- increase indicate impaired gas exchange-> hypoventillation, partial airway obstruction, rebreathing exhaled air
- cellular metabolism-fever, acidosis, heavy exercise
capnography readings-decrease
- poor pulm ventilation
- pulm embolism, apnea, total airway obstruction, tracheal extubation, hyperventilation
Pt education for pulm function tests
- don’t smoke 6-8 hrs prior
- bronchodilator drugs may be withheld for 4-6 hrs
- reduce anxiety by explaining procedure
