Nursing Diagnoses for Pulmonary Fibrosis

With pulmonary fibrosis there are many different nursing diagnoses and nursing interventions that one can make to help out their patient and allow them to live a much more normal life. Many of these nursing diagnoses are things that one can expect to happen to someone with this condition and the nursing interventions are the steps that can be made by the nurse and patient to help the patient to get through these problems with less complications and discomfort.

           

One of the most important nursing diagnoses is poor gas exchange. This normally happens because of all of the pulmonary scarring. With this nursing diagnosis the nurse mostly needs to listen to the patients respiratory sounds to make sure they are normally and they need to look for the telltale signs of poor oxygen saturation which are change in mental status, change in skin color, and trouble breathing. It also helps to raise the head of the bed so the patient can breath easier. 

Another nursing diagnosis is an imbalanced nutrition. This normally happens due to the fatigue, medications, and low oxygen levels that come with many respiratory diseases. To help with poor nutrition it is best for the nurse to really listen to the patient and to give good education. It can also be helpful to weigh the patient and help them to make a scheduled diet.

A third nursing diagnosis for pulmonary fibrosis is risk for infection. This is due to the lowered immune response in the lungs, malnutrition, and low oxygen levels. As a nurse it is important to monitor temperature frequently, to be cautious with visitors, and to discuss how important nutrition and adequate intake are when you are sick.

Activity intolerance is a fourth nursing diagnosis. Activity intolerance is normally from the fatigue that comes with the low oxygen levels. To help with this a nurse should assess the amount of energy the patient has and help them to make guidelines and schedules to at least exercise some a day. It's also good for the nurse to help wherever it seems necessary with activities of daily living. 

The last nursing diagnosis is alteration in comfort due to pulmonary fibrosis. As a nurse it is very helpful to give pain medications as seems fit and to respond quickly to complaints of pain. It is also good to try some non-pharmaceutical methods and to make sure they are comfortable enough to get the rest that they need.

All of these diagnoses and interventions are very important when dealing with someone with pulmonary fibrosis but the most important thing to remember is to always treat for your specific patient. Here is a great website to help know how to care for someone with respiratory diseases! 

http://nursingcrib.com/nursing-notes-reviewer/nursing-diagnosis-for-respiratory-diseases/

Poor Gas Exchange	Nursing Diagnosis
Actual or Potential	Impaired gas exchange from scarring
Related To	Altered oxygen supply, alveolar scarring, alveolar capillary membrane changes
Plan and Outcome	Improve ventilation, adequate oxygenation, no signs of respiratory distress, pulse oximeter levels above 95%
Nursing Interventions	Assess and record respiratory function, elevate head of bed, routinely monitor skin coloration, encourage cough to get rid of sputum, monitor level of consciousness, evaluate sleep and comfort.

References:

"EHS: Nursing Diagnosis Care Plans, 4/e - Pain." EHS: Nursing Diagnosis Care Plans, 4/e - Pain. Web. 1 Mar. 2015. <http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick39.html>.

"Pulmonary Fibrosis - Care Guide." Pulmonary Fibrosis - Care Guide. Web. 1 Mar. 2015. <http://www.drugs.com/cg/pulmonary-fibrosis.html>.

Nursing Diagnosis for Respiratory Diseases | Nursing Crib (Nursing Crib)

http://nursingcrib.com/nursing-notes-reviewer/nursing-diagnosis-for-respiratory-diseases/

Nursing Care of Patients with Pulmonary Fibrosis

         Caring for a patient with pulmonary fibrosis can be a challenging experience because the disease doesn’t exactly have a cure. Most of the care given to these patients is meant to help them be more comfortable. While giving nursing care for these patients there are a few things that you should always remember. First off most of the patients with pulmonary fibrosis are older so you should always look into any other problems they may have or any additional medications they could be on. There are also a lot of co-morbities that go along with pulmonary fibrosis that you need to look out for. These include gastroesophageal reflux disease (GERD), pulmonary hypertension, coronary artery disease, diabetes, lung cancer, obstructive sleep apnea and other sleep disturbances, pulmonary embolism, and emphysema

         Dyspnea or shortness of breath is another problem that many patients with pulmonary fibrosis have. As a nurse it is always a good idea to evaluate your patients for any shortness of breath or any exercise induced trouble breathing. If they have either of these you can try to get them a referral for oxygen therapy so they can be more comfortable while doing things inside and outside. A group of exercises called pulmonary rehabilitation can also be helpful with dyspnea.

         Many pulmonary fibrosis patients also get a very uncomfortable and annoying cough. This symptoms is a bit hard to treat but studies have shown that oral corticosteroids, mucolytic drugs, and codeine are helpful. Fatigue and de-conditioning are also very common with pulmonary fibrosis patients. This happened to them mostly because of low oxygen levels that then lead to muscle de-conditioning. The best way to treat this is by giving supplemental oxygen and to prescribe them to rehabilitation.

         The last common symptom of pulmonary fibrosis that needs special nursing care is depression and anxiety. Because of the poor prognosis and lack of cure of pulmonary fibrosis many patients experience depression. As a nurse it is extremely important to pay close attention to patients and to keep them very well educated about their disease. If they show any signs of depression it is best to refer them to psychosocial support.

         Pulmonary fibrosis is a horrible disease and there are many things that you need to pay close attention to as a nurse but some of the most important things to do are to keep the patient educated and to encourage them to speak up if they are having any problems. A great website for patient education can be found at http://www.medscape.com/viewarticle/748592. This website is really helpful because it has information that is both informative and helpful. It helps explain the problems one may be experiencing and it also gives ways to fix these problems.

Disease centered management	Education and Self-Management	Symptom-Centered Management
Pharmacologic Therapy	Knowledge	Dyspnea
Non Pharmacologic Therapy	Values and preferences	Cough
Co-Morbidities and Complications	Advanced care planning	Fatigue and Deconditioning
Preventative care		Depression and Anxiety

References:

Lee, Joyce, Sally Mclaughlin, and Harold Collard. "Comprehensive Care of the Patient with Idiopathic Pulmonary Fibrosis." Medscape Log In. 1 Jan. 2011. Web. 22 Feb. 2015. <http://www.medscape.com/viewarticle/748592>.

 "Management of Idiopathic Pulmonary Fibrosis." Web. 22 Feb. 2015. <http://www.nursingtimes.net/Journals/2014/04/11/p/n/x/160414-Management-of-idiopathic-pulmonary-fibrosis.pdf>. 

Pulmonary Fibrosis Treatment

While there are many diseases that have standard treatments that will cure the disease, pulmonary fibrosis is different. Currently pulmonary fibrosis is incurable and once you are diagnosed with it you will have it for the rest of your life. While there is no treatment for pulmonary fibrosis there are some procedures that can be done to help manage symptoms. No treatment for pulmonary fibrosis is standard though so any treatment that one will be given will be made specialized for that specific patient based on their symptoms and medical history.

            There are two main types of treatments for pulmonary fibrosis, which consist of pharmacological and non-pharmacological. Within non-pharmacological measures there are a lot of strategies that one can do to manage symptoms and prevent future complications. The most straightforward treatments in this category are to stay away from smoking of any kind, to get vaccinated so you don’t catch any bugs that can harm your lungs, and to maintain a healthy weight. You can also monitor your oxygen saturation at home with pulse oximetry to make sure your lungs are functioning properly. It is important to always be above 90%. Another thing that you can do is something called pulmonary rehabilitation. With pulmonary rehab you have a structured exercise program with the goal of restoring one’s respiratory function without causing extreme breathlessness. This has become a very important part of many people’s treatment with lung diseases.

            Along with the many helpful non-pharmacological treatments there are also many pharmacological treatments that can do a lot to help people with pulmonary fibrosis. Corticosteroids, cyclophosphamide, azathioprine, and mycophenolate mofetil are common medications used for pulmonary fibrosis which help to suppress the immune system and inflammation. Both of these are some of the main causes of pulmonary fibrosis so suppressing them really helps to slow down the scarring of the tissue.  Nintedinib and pirfenidone are two medications that are also helpful and are both classified as anti-fibrotic drugs. This means that they help to lessen the scarring in the lungs. The last type of medication is supplemental oxygen. This just helps to get more oxygen into your blood so that your body works better. The main drug that causes side effects is prednisone and the most common of these are aggression, agitation, dizziness, mood changes, headache, and irritability. There are many drugs that are prescribed for pulmonary fibrosis but the drugs chosen normally depend a lot on how your pulmonary fibrosis is progressing.

            If none of these therapies are working the only option left is to do a lung transplant. These are extremely risky though and can only be done on patients that are in very good health. Life after the transplant can also be pretty hard because you have to stay on life long antirejection drugs and sometimes the transplant doesn't work out. The treatment for pulmonary fibrosis is still evolving and changes every day and hopefully a better treatment will be found soon.

References

"Treatment Options." Treatment Options. Web. 15 Feb. 2015. <http://www.pulmonaryfibrosis.org/life-with-pf/pulmonary-fibrosis-treatment-options>.

"Pulmonary Fibrosis Symptoms, Prognosis, Treatments, and More." WebMD. WebMD. Web. 15 Feb. 2015. <http://www.webmd.com/lung/pulmonary-fibrosis?page=2>.

Signs and Symptoms

            Pulmonary fibrosis has a large number of defining signs and symptoms that occur with most people that have the disease. The most defining and first found symptom of pulmonary fibrosis is dyspnea, also known as shortness of breath.  At first people normally just have shortness of breath while exercising but over time this shortness of breath happens even when at rest. This dyspnea is normally accompanied by a dry, hacking, cough that doesn’t get better. After awhile people sometimes have repeated bouts of this hacking cough that are uncontrollable.  Most of the other signs and symptoms of pulmonary fibrosis are brought on from the lack of appropriate oxygen in the blood and happen with progression of the disease.

            Other common symptoms of pulmonary fibrosis that develop over time are rapid shallow breathing, aching muscles and joints, and fatigue or tiredness. This rapid shallow breathing happens because one’s body is trying to compensate for the lack of oxygen exchange in the lungs due to the scarring by breathing faster and more often. This lack of oxygen is also what causes the tiredness and aching. Another main symptom is clubbing of the fingers. This is described as a widening and rounding of the tips of one’s fingers and sometimes toes. This is another common symptom of people that have low oxygen levels in their blood. Many people also complain of a gradual and unexplained weight loss along with their other symptoms.

            Over time as the scarring of the lungs worsens and the oxygen exchange worsens people start to develop more problems due to long term low oxygen blood levels. These include many lung problems like lung cancer, blood clots in the lungs (also known as a pulmonary emboli), pneumonia, and high blood pressure in the blood vessels that supply the lungs. In a worst case scenario the patient will develop multiple system organ failure, which is basically where a lot of their organs stop working due to the long-term lack of oxygen in the blood. This will happen frequently to the kidneys and liver first.

            Normally the long-term cough and the constant dyspnea are what bring a patient into the hospital seeking care for their pulmonary fibrosis. These are also the symptoms that are the most uncomfortable for the patient other than the symptoms found in the very late stages of the disease, like lung problems and organ failure. Pulmonary fibrosis has many symptoms, but the key to understanding comes with understanding how the body reacts to low oxygen levels.

Reference:

Idiopathic pulmonary fibrosis. (2010, October 1). Retrieved February 8, 2015, from http://ghr.nlm.nih.gov/condition/idiopathic-pulmonary-fibrosis

What Are the Signs and Symptoms of Idiopathic Pulmonary Fibrosis? (2011, September 20). Retrieved February 8, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/ipf/signs

Pulmonary fibrosis. (n.d.). Retrieved February 8, 2015, from http://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/basics/symptoms/con-20029091

How Do They Know You Have Pulmonary Fibrosis???

Pulmonary fibrosis is still a bit of a mystery to the medical world so its diagnosis is a bit lengthy and usually involves a few different procedures. There are three different types of diagnostic tests, which include the categories of imaging, lung function, and tissue sampling. All of these types of tests look at one’s lungs, how they are working, and if they have any scaring. 

X-rays and CT scans are the main types of imaging tests done for pulmonary fibrosis. A CT scan is when they use a computer to put together a ton of X-rays to make a 3 dimensional image of a part of someone’s body.  A doctor can normally see the scarring on someone’s lungs with an X-ray or CT scan but sometimes the images look normal so further tests are needed to figure out if someone truly does have pulmonary fibrosis.

                                                                     Normal

 Pulmonary Fibrosis

The second type of test done to find out if someone has pulmonary fibrosis is lung function. With lung function tests they are just looking at how well your lungs are working. One type of lung function test they use is called a pulmonary function test. With this test they are looking at how much air one is able to exhale. The other type of test is oximetry. With oximetry they put a small device on your finger and test the oxygen saturation of your blood. With this test they will normally have you try exercising while wearing the device too to see how well your lungs can keep up when you’re exercising. 

The last type of test is a biopsy or tissue sample. This is the most reliable form of testing but also the most invasive. It’s the only form of testing that allows you to decisively diagnose pulmonary fibrosis as well. While all of the forms of tissue sample are the same, the only difference is how you get the sample. There are three different ways to obtain the sample. The least invasive is a bronchoscope where they go down into the patient’s lungs and just pull out a very small amount of tissue. The second method is called a Broncho alveolar lavage, which is where they spray salt water into the lungs with the bronchoscope then suction up the fluid. The third and final method is through surgery. This is the most intrusive method but it is also the best way to get a large sample.

The progression of pulmonary fibrosis is extremely varied depending on the type and on the person. Sometimes it will progress slowly and sometimes it will progress extremely quickly. It really depends on the person. When it does progress though, it is because your lungs are becoming more and more scarred. 

References:

 Pulmonary fibrosis. (n.d.). Retrieved February 1, 2015, from http://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/basics/tests-diagnosis/con-20029091 

How Is Idiopathic Pulmonary Fibrosis Diagnosed? (n.d.). Retrieved February 1, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/ipf/diagnosis