Question

Oxygenation, Perfusion, fluid and electrolytes are concepts reflect normal physiological mechanism occurring inside the human body which may be affected by the pathological conditions and at the same time can lead to new pathological one.

Perfusion concept and apply it on lung fibrosis showing the following:

1. Introduction about the selected concept(s)
2. Brief introduction about lung fibrosis
3. Focus on the physiological changes on the selected concept(s) associated with lung fibrosis in relation to:

1. Clinical S & S
2. Diagnostic measures
3. Management (medical, surgical & nursing management).

Answer 1

OXYGENATION

Oxygenation is the process of oxygen diffusing passively from the alveolus to the pulmonary capillary , where it binds to haemoglobin in red blood cells or dissolves into the plasma . Insufficient oxygenation is termed as hypoxemia . Hypoxia is an abnormally low oxygen content in a tissue or organ . Process of oxygenation includes ; ventillation , diffusion , transportation , and perfusion .

   PERFUSION ;   

Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue , usually referring to the delivery of blood to a capillary bed in tissue . Perfusion is measured as the rate at which blood is delivered to tissue, or volume of blood per unit time per unit tissue mass . Poor perfusion , that is ischemia , causes health problems like cardiovascular diseases , cerebrovascular diseases , peripheral artery diseases , and other many concerns .

FLUID ELECTROLYTE BALANCES

Total body water composes about 60 % of body weight . A variety of key electrolytes are dissolved in body fluids to maintain organ function and fluid balance . The gastrointestinal tract , kidneys , and the endocrine syatem plays a major role in fluid and electrolyte balance in our body . The respiratory system helps to maintain the bodys acid base balance .

LUNG FIBROSIS

Lung fibrosis ( pulmonary fibrosis ) is a lung disease that occurs when lung tissue becomes damaged and scarred . This thickened , stiff tissue makes it more difficult for the lungs to work properly . As pulmonary fibrosis worsens , you become progressively more short of breath . The main causes of pulmonary fibrosis includes ;

• Occupational and environmental factors ( silica dust , asbestos fibers , coal dust , hard metal dusts )
• Radiation treatments
• Medications ( chemotherapy drugs , heart medications, some antibiotics , anti - inflammatory drugs )
• Medical conditions ( dermatomyositis , polymyositis , SLE , rheumatoid arthritis )

PATHOPHYSIOLOGICAL CHANGES IN PULMONARY FIBROSIS .

In lung fibrosis the alveolar epithelial cells appear to become damaged and begin to die . The body tries to repair the damage by releasing another type of cell known as fibroblasts . The production of these fobroblasts goes out of control and they cause scarring and hardening ( fibrosis ) of the delicate tissues of the lungs . This leads to difficulty of expansion of lung tissue - making breathing difficult in the affected patient . The lung tissue also has issues transferring oxygen to the rest of the body . As a result patient develops symptoms like shortness of breath and dry cough .

Common problem with pulmonary fibrosis is the slow development of leg swelling or edema . This process is maladaptive response to progressive lung disease. In pulmonary fibrosis as the disease progresses , the right side of the heart gradually has to work harder to pump blood through fewer blood vessels . As a means of compensating , the brain releases hormones that prompt the kidneys to retain salt and water . As this process progresses , patient slowly retain more and more fluid .Abdominal swelling is also a problem in pulmonary fibrosis .

SIGNS AND SYMPTOMS OF LUNG FIBROSIS

• Shortness of breath ( dyspnea )
• A dry cough
• Fatigue
• Unexplained weight loss
• Aching muscles and joints
• Widening and rounding of the lips of the fingers or toes ( clubbing )

DIAGNOSTIC MEASURES

1. Imaging tests

• chest x-ray
• CT scan
• Echocardiogram

2. Lung function tests

• pulmonary function testing
• pulse oxymetry
• Exercise stress test
• Arterial blood gas test

3. Tissue sample biopsy

• Bronchoscopy
• Surgical biopsy

4 . Blood tests to evaluate kidney and liver function

TREATMENT

MEDICAL MANAGEMENT

• Medications ( pirfenidone and nintedanib )
• Oxygen therapy
• pulmonary rehabilitation

SURGICAL MANAGEMENT

Lung transplant ; Lung transplantation may be an option for people with pulmonary fibrosis . Having a lung transplant can improve the quality of life and allow to live a longer life . But this can have complications such as rejection and infection .

NURSING MANAGEMENT

Nursing diagnoses ;

• Impaired gas exchange related to excess scar tissue in the lungs secondary to pulmonary fibrosis as evidenced by shortness of breath with exertion
• Activity intolerance related to imbalance between oxygen supply or demand as evidenced by patient inability to walk short distances .
• Powerlessness related to effects of illness and oncoming death as evidenced by no motivation in activities or events .

Interventions

• Monitor the respiratory rate , depth and work of breathing
• Encourage coughing and deep breathing exercises and frequent position changes to promote lung expansion and drainage of secretions .
• Assist with repositioning to maintain clear airway and ventillation .
• Administer oxygen therapy to decrease the lungs work .
• Encourage regular exercise , as it helps to maintain the physical wellness .
• Palliative care
• Involve in pulmonary rehabilitation
• Look for any comorbidities like gastroesophageal reflux diseases