Prepared by:

Mr. S.Somorjit Singh,MSc.(N)

Lecturer.

COPD

(Black & Hawks, p 1814-1829)

 Combination of disorders that affect the movement of air through the lungs including chronic bronchitis, emphysema and asthma

· limitation of flow of air to and from the lungs

· often caused from cigarette smoking or noxious particles, heredity, childhood respiratory illness

· leads to decreased ciliary function, inflammation, and damage to bronchiolar and alveolar walls

· poorly reversible and progresses over time

· 4th leading cause of death in US

· 42.6 billion in health-care costs and lost productivity 

 CLINICAL MANIFESTATIONS:

CHRONIC BRONCHITIS:

· “Barrel Chest”

· pursed-lip breathing, use of accessory muscles

· wheezing

· persistent cough, sputum production

· decreased Pao2, increased PaCo2

· dependent edema, elevated hematocrit

· Continues for at least 3 months of the year for 2 consecutive year with chronic bronchitis or obstructive lung disease with chronic cough

EMPHYSEMA:

· tachypnea, pink skin color

· persistent SOB with progressive exertional dyspnea

· progressive deterioration

· PaO2 normal or slightly decreased, PaCo2 low or normal until end stage

· No edema, diminished breath sounds on auscultation

Enlarged view of lung tissue showing the difference between healthy lung and COPD:

VIDEOS:

http://www.youtube.com/watch?v=aktIMBQSXMo

ADMINISTERING OXYGEN:

http://www.youtube.com/watch?v=XFieSB3TzK4

MANAGEMENT:

· improve ventilation

· facilitate removal of bronchial secretions

· prevent complications

· slow progression of disease

· pulmonary hygiene (postural drainage, suction, chest physiotherapy)

· smoking cessation!!

· collaborate with nutrition therapy to help prevent muscle atrophy

· exercise therapy

· adequate hydration

· anxiety control

· incentive spirometer use (ten times an hour while awake)

MEDICATIONS:

· bronchodilators (reduce airway obstruction)

· beta 2 antagonists

· anticholinergics

· methylxanthines (theophylline, aminophylline)

· corticosteroids to reduce inflammation and edema

· available in parenteral, oral, and inhalation forms

· oxygen is used when pt has severe exertional or resting hypoxemia

· OXYGEN THERAPY… be cautious, patients with emphysema have a respiratory drive from low oxygen levels rather than high CO2 levels, retention can occur

SURGERY:

· sometimes an option to remove damaged lung

· lung transplantation

· bullectomy, to remove a bulla, or large air-filled space compressing on the lung

POSSIBLE NURSING DIAGNOSES:

· Impaired gas exchange

· Ineffective airway clearance

· Activity intolerance

· Imbalanced nutrition, less than body requirements

· Risk for infection

· Self-Care deficit

· Deficient knowledge

Chronic Obstructive Pulmonary Disease

Group 2: Jaime Overby, Sheree Landers, Lisa Webster, Megan Iturralde

Chronic obstructive pulmonary disease (COPD) is a combination of chronic obstructive bronchitis, emphysema, and asthma.

Chronic obstructive bronchitis results from inflammation of the bronchi, increased goblet cells and impaired ciliary function. This leads to increased mucus production with chronic cough and reduces mucus clearance. This combination increases risk for infection. When infection occurs mucus production increases and bronchial walls become inflamed and thick. In the beginning chronic obstructive bronchitis only affects the large bronchi, but eventually all airways become involved. The thick mucus and inflammation obstruct the airway mostly during expiration.  The airways collapse trapping air in the distal portion of the lung. People with chronic obstructive bronchitis as the primary disease demonstrate a productive cough, shortness of breath, wheezing, decreased exercise tolerance, prolonged expiration, and suffer from hypoxemia and hypercapnia. The typical sitting position is leaning over a table with shoulder girdle raised (Black pg 1577-1580, 1586).

Emphysema is a disorder where the alveoli walls are destroyed; this destruction leads to permanent over distention of the air spaces. These changes lead to obstruction of the air passages. The work of breathing is increased because of less functional lung tissue to. There are three types of emphysema. The first is centriacinar this is the most common type. It produces destruction in the bronchiole affecting the upper lung region. The second type is panacinar this destroys the entire alveolus and involve the lower portion of the lung. The third type is paraseptal emphysema this involves distal airway obstruction, alveolar ducts and alveolar sacs. Clients with primary emphysema have progressive dyspnea, the anteroposterior diameter of chest is enlarged and the chest has hyperresonant sounds when percussed (Black pg 1580, 1586).

Picture: X-ray of patient with emphysema

Picture from: http://www.meddean.luc.edu/Lumen/MedEd/Radio/curriculum/Medicine/emphysema.htm

Asthma is a disorder of the bronchiole airway characterized by periods of reversible bronchospasms. Asthma involves a chronic inflammation process that produces mucosal edema, mucus secretions, and airway inflammation. When exposed to allergens or irritants  the airway becomes inflamed causing shortness of breath, chest tightness, wheezing “aeb” nasal flaring pursed lip breathing, use of accessory muscles and cyanosis in late stages. (Black pg 1570-1571).

Great video on the complex issue of O2 administration for COPD patients:

URL of video: http://www.youtube.com/watch?v=XFieSB3TzK4

COPD is the fourth leading cause of death in America. Risk factors for COPD include; smoking (#1), air pollution, second hand smoke, history of childhood respiratory infections, heredity and occupational exposure.  Medical management includes; improve ventilation, removal of bronchial secretions, reducing complications and improving general health (Black pg 1578, 1586-1589).

Web Link for further information: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html