Lung disorders
Asthma
Asthma is a long-term chronic breathing problem that can
affect people of any age. It may be inherited, or may be caused by allergies to
pollen, pets, dust, or medications. Smoking increases the risk of developing
asthma, and stress may make it worse. Persons with asthma can live normal lives
with medication and proper care.
A person with asthma has sensitive bronchi
that react to triggers such as smoke, air pollution, cold weather, exercise, or
allergies. The bronchi may tighten or narrow, becoming inflamed and swollen, making
it harder to breathe fresh air in and exhale the stale air. Sometimes it is
harder to exhale than inhale. Symptoms of asthma are wheezing, dry cough, or
sometimes a cough with mucus, shortness of breath, and chest tightness.
Medications may include an inhaler,
puffer, or pills. Some medicines reduce the swelling and inflammation in the
bronchi, helping to prevent asthma attacks from starting, but they do not stop
an attack once it has started. Inhalers work quickly, opening the narrowed
airways. They help stop an attack once it has begun and are used as needed.
Some asthma drugs may cause irregular heartbeats.
Blood pressure medicines, sleeping pills,
tranquilizers, sedatives, or aspirin may cause a problem in older people with asthma.
These drugs make one breathe more slowly and less deeply, which can be dangerous
if one has asthma.
Common symptoms
of respiratory problems
These symptoms should
be reported to your supervisor:
‰ Cough—varies
with type of problem. Take notice of these things:
o Is the cough
dry, without sputum?
o If there is sputum with the
cough, what color is it? Is there any blood in the sputum? Is the sputum thick
or thin?
o What factors
affect the cough, such as walking, talking, eating, etc.?
Two kinds of medicines are used to
treat coughs. Antitussives suppress the cough, and expectorants help loosen
mucus so it can be coughed up.
‰ Shortness of breath (SOB, dyspnea) is
the unpleasant sensation of breathlessness or difficulty in breathing.
Shortness of breath may happen mostly during activity, when it is often called
distress on exertion, or DOE. Some people feel short of breath all the time because
of narrowed airways. Sometimes shortness of breath occurs when lying down. This
is usually due to heart failure and is relieved by sitting up.
‰ Breathing
that is abnormal—too fast, too slow, irregular, shallow, or gasping.
‰ Pleurisy is a sharp pain caused by
an irritation in the lining of the lungs. It is made worse by deep breathing
and coughing. Sometimes the area is sore to the touch.
‰ Cyanosis
is a bluish color of the lips, nails, and skin caused by lack of oxygen.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is the name for reduced airflow
in to and out of the lungs. It is associated with diseases such as emphysema
and chronic bronchitis. Smoking is the cause of 80%–90% of COPD. Other causes
include heredity, second-hand smoke, and air pollution. There is no cure.
Bronchitis is an
inflammation of the bronchi. In chronic bronchitis the airways become narrow,
scarred, and partly clogged with mucus, making it difficult to breathe. There
may be a cough that lasts for months and returns often, lasting longer each
time.
Emphysema occurs when some
of the air sacs deep in the lungs are damaged, often because of long-term
infection and irritation. When lung tissue is damaged, the airways collapse,
trapping stale air and blocking intake of fresh air. The lungs try to take in
more air and become over-inflated and stretched out, gradually getting so big they
completely fill the chest cavity. Many with severe emphysema develop a barrel- shaped
chest because of this.
The stretched-out lungs cannot effectively
exhale, creating the feeling that something is blocking the airway. Stale air
is never completely replaced with fresh air, and less oxygen gets into the
blood. Emphysema makes the heart work harder, eventually leading to heart
failure.
Many people with emphysema lose 50–70%
of their lung tissue before they are
aware of symptoms. A daily morning cough with clear sputum
is the earliest symptom. Gradually the morning cough becomes an all-day cough.
Sometimes the first symptom people notice is breathlessness, especially with
activity. Other symptoms of COPD include chest tightness and increased mucus.
Care measures for COPD:
→Medications.
→Oxygen therapy.
→Good nutrition and correct body weight.
→Good ventilation. People with COPD often like to have a fan
blowing air toward them.
→Rooms should be at a comfortable, moderate temperature, not
too hot, too cold, or too humid. Showers and baths should be quick if moisture
in the air makes breathing difficult.
→Loose-fitting clothes are best.
→Avoid dust, allergens, air pollution, smoke, and other
irritants. Animal hair, scented soaps, colognes, perfumes, powders, cleaners,
aerosol sprays, glues, and paints can all cause problems with breathing.
→Exercise can strengthen, improve well-being, and reduce
shortness of breath.
→Drinking lots of water will keep secretions thin and easy
to bring up.
→Tasks should be broken into short segments with frequent
rest periods of at least 5–15 minutes.
→Sit when performing tasks if possible.
→Relaxation exercises and special breathing techniques can
help the COPD client feel better.
→Caregivers must give frequent support, encouragement, and
reassurance.
→Be patient, be complimentary, and keep a positive attitude
with COPD clients. They often feel anxious and irritable. Lack of oxygen in the
blood can cause fatigue, forgetfulness, depression, confusion, poor appetite,
moodiness, agitation, frustration, and sleeplessness.
Breathing
techniques and relaxation exercises that help those who feel breathless
Pursed-lip breathing is helpful in many cases of
shortness of breath. It improves ventilation, reduces air trapped in the lungs,
relaxes the client, and eases the effort of breathing. This is especially good
to do while exercising or performing any physical activity:
→An erect, upright posture is best for full lung and chest
expansion.
→Breathe in slowly through the nose for 1 count. Feel lungs
fill with air.
→Purse lips slightly as if to whistle.
→Breathe out gently and slowly through pursed lips for 2
slow counts.
→Do not force the air out; let it escape naturally.
→Keep doing this until breathing eases.
Clients can learn controlled coughing
techniques to help clear the breathing passages:
→Take a slow, deep breath and hold for 2 seconds.
→Cough twice, with mouth slightly open. The first cough
should loosen mucus,
and the second should push it out of the lungs.
→Pause. Sniff gently. Do not take a deep breath, as this may
push mucus back to the lungs.
The orthopneic position can
help clients with enlarged lungs breathe better by stabilizing the chest and
shoulders and helping the client use other muscles to support breathing:
→Sit leaning forward. Support the arms on a surface in
front. An overbed table provides good support and can be adjusted to the right
height. Arms can also be supported on the knees.
Relaxation and visualization
exercises can calm anxiety and agitation:
→Sit in a chair with eyes closed
and do pursed lip breathing for a minute or two.
→Frown, tightening the muscles in
the forehead. Hold for 3 seconds and then relax.
→Clench jaw by tightening the
muscles in the lower jaw. Hold for 3 seconds and relax.
→Tighten and relax arms and hands,
then buttocks, then legs and feet.
→Let the body go limp.
→Imagine the most peaceful scene
you can think of.
→Visualize the scene with you in
it. Think of as much detail as possible.
→Think about how relaxing it is to
be in that place and how easily you can breathe there.
Energy conservation measures can help clients
accomplish tasks with less effort:
→Push or slide objects instead of lifting them. Wheeled carts
are helpful.
→To stand, take several slow, deep breaths, then stand while
breathing out through pursed lips.
→Always exhale when lifting or pushing heavy objects or when
doing an action or exercise.
→When climbing stairs, use pursed-lip breathing, stop often
to rest, and use the rail for support.