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COPD Ms. Gardner NUR - 224. COPD. Chronic Obstructive Pulmonary Disease a slowly progressive obstruction of the airways currently is 4th leading cause of death the 12th leading cause of disability.

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Copd ms gardner nur 224

COPDMs. GardnerNUR - 224


COPD

Chronic Obstructive Pulmonary Disease

  • a slowly progressive obstruction of the airways

  • currently is 4th leading cause of death

  • the 12th leading cause of disability.

  • includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these disorders.

  • Asthma is now considered a separate disorder but can coexist with COPD.


Copd pathophysiology
COPD -Pathophysiology

  • Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious agents.

  • This process causes airways to narrow  resistance to airflow increases and expiration becomes difficult or slow.

  • The result is a mismatch between alveolar ventilation and blood flow or perfusion  impaired gas exchange.


  • COPD versus Asthma

  • Asthma is now considered a separate

  • reversible disorder

  • No longer under the diagnosis of COPD

    • Uncontrolled asthma over a

  • lifetime may result in COPD

  • COPD is not reversible


  • Chronic bronchitis
    CHRONIC BRONCHITIS

    • A disorder of excess bronchial mucus secretion

    • Productive cough

    • Cigarette smoking

    • Inhaled irritants

    • Mucous-secreting glands and goblet cells increase in number.

    • Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways.



    Emphysema
    EMPHYSEMA

    • Impaired oxygen/carbon dioxide exchange

    • Decreased alveolar surface area

    • Hypoxemia result.


    Emphysema1
    EMPHYSEMA

    • Alveoli walls continue to breakdown, pulmonary capillary bed is reduced resistance to pulmonary blood flow is increased  forcing the ( R) ventricle to maintain a higher pressure in the pulmonary artery.

    • Increased pulmonary artery pressure may cause right-sided heart failure (corpulmonale).



    Risk factors
    RISK FACTORS

    • More common in Whites than Blacks

    • Affect men more frequently than women

    • Affects middle-aged and older adults

    • Tobacco smoke causes 80-90% of COPD cases!

    • Occupational exposure

    • Genetic abnormalities

      Alpha1-antitrypsin deficiency


    Cigarette smoking
    Cigarette Smoking

    • affect’s the respiratory tract ciliary cleansing mechanism

    • airflow is obstructed

    • irritation of the goblet cells/mucous glands  increase mucous production


    Clinical manifestations
    CLINICAL MANIFESTATIONS

    3 primary symptoms

    • chronic cough

    • sputum production

    • dyspnea

    • Weight loss

    • Barrel chest

    • Pursed lip breathing



    Assessment diagnostic findings
    ASSESSMENT/DIAGNOSTIC FINDINGS

    • Health history

    • Pulmonary function test

    • Spirometry

    • ABG- PCO2 >45 / PaO2 60-80

    • Screening – alpha 1 – antitrypsin deficiency

    • CBC – RBC/Hct.

    • Key factor dx. – patient’s history/responsiveness to bronchodilators


    Collaborative complications
    COLLABORATIVE COMPLICATIONS

    • Respiratory insufficiency

    • Pneumonia

    • Chronic atelectasis

    • Pulmonary arterial hypertension (cor pulmonale)


    Medical management
    MEDICAL MANAGEMENT

    Risk reduction –

    • smoking cessation / most cost - effective intervention

      nicotine replacement – gum, inhaler, nicotine patch,

      positive reinforcement/patient teaching

    • immunization against pneumococcal pneumonia/influenza vaccine  reduce the risk of respiratory infection

    • Pharmacologic Therapy


    Medical management1
    MEDICAL MANAGEMENT

    Bronchodilators

    • Delivered –

      meter-dose inhalers

      dry powder inhalers

      spacer holding chambers

      nebulizers


    Drug therapy bronchodilators
    DRUG THERAPYBronchodilators

    • Beta2-Adrenergic agonists

      Proventil (albuterol)

      Alupent (metaproterenol)

      Brethine (terbutaline)

    • Anticholinergics

      Atrovent (ipratropium bromide)

    • Methylxanthines

      Aminophylline (Phyllocontin)

      Theophylline (Slo-bid; Theo-Dur)

    • Combination meds


    Drug therapy
    DRUG THERAPY

    Corticosteriods

    • May improve the symptoms of COPD  do not slow the decline of lung function

    • Short term therapy may improve pulmonary function and exercise tolerance .

    • Long term therapy not recommended

      Other medications

    • antibiotics, mucolytic agents, antitussive agents,


    Oxygen therapy
    OXYGEN THERAPY

    • Long term continuous therapy, during exercise, prevent acute dyspnea, during exacerbation

    • Goal to improve mental functioning and quality of life and reduce the work load of breathing

    • O2 sat -90%

    • Low flow devices most common

    • COMPLICATIONS of O2 THERAPY

      to much O2  CO2 retention


    Copd other treatments
    COPDOTHER TREATMENTs

    Surgical Management

    Bullectomy

    Lung Volume Reduction Surgery (LVRS)

    Transplant


    Patient education
    PATIENT EDUCATION

    • Breathing exercises

    • Activity pacing

    • Oxygen therapy

    • Nutrition therapy

    • Coping measures


    Copd nursing diagnoses
    COpdNursing diagnoses

    • Ineffective airway clearance

    • Impaired gas exchange

    • Imbalanced nutrition

    • Risk for infection


    Home community
    Home/ Community

    • Knowledge of s/s of infection

    • Increase exercise tolerance and prevent further loss of pulmonary function

    • Avoid extremes of heat and cold

    • Avoid stress/emotional disturbances

    • Demonstrate how to use MDI prior to discharge

    • Smoking cessation

    • Utilize resources – home care, support groups, organizations -> American Lung Association


    Asthma
    ASTHMA

    • Chronic inflammatory disease of the airways  episodes of wheezing, breathlessness, chest tightness, and coughing.

    • Most episodes of asthma ”attacks” are brief

    • Acute episodes usually reverse either spontaneously or with treatment


    Asthma1
    ASTHMA

    • Affects more than 22 million people

    • Accounts for more than 497, 000 hospitalizations annually

    • Common chronic disease of children – occurs at any age

    • More common in women than men

    • Patients may experience symptom – free periods alternating with acute exacerbations  last from minutes to hours, to days.


    Asthma2
    ASTHMA

    Pathophysiology

    • airways are in a persistent state of inflammation

    • during this period, neutrophils, and lymphocytes play a role in the inflammation of asthma.

    • when activated they produce chemicals that enhance the inflammatory response  increase blood flow, vasoconstriction

    • inflammation progresses  airway edema, bronchoconstriction and mucous secretion - narrows the airway


    Asthma3
    ASTHMA

    CONT’D

    • resistance increases, limiting airflow and increasing the work of breathing.

    • trapped air mixes with inspired air in the alveoli  affecting gas exchange  hypoxemia

    • hypoxemia  hyperventilation  decrease in PaCO2  respiratory alkalosis


    Asthma4
    ASTHMA

    • Predisposing factors/Triggers:

    • exposure to allergens

    • inhaled irritants

    • respiratory tract infection

    • stress, medications, exercise


    Asthma5
    ASTHMA

    Clinical manifestations

    • Chest tightness, non-productive cough, dyspnea, wheezing

    • Often occurs at night or early in morning

    • Onset

    • Attack may subside rapidly or persist for hours/days

    • During an attack


    Asthma6
    ASTHMA

    Assessment/Diagnostic findings

    • Episodic symptoms of airflow obstruction

    • Positive family history

    • Pulmonary function test

    • ABGs


    Asthma7
    ASTHMA

    Preventive Measures

    • Avoiding allergens/environmental triggers

    • Modifying home environment

    • Early treatment of respiratory tract infection


    Asthma8
    ASTHMA

    Medical Management /Medications therapy

    • Quick relief medications

    • Long acting medications


    Asthma9
    ASTHMA

    Quick relief medications

    • Beta2- agonists

    • albuterol (Proventil) /levalbuterol (Xopenex)

    • Administered by MDI/DPI

    • Act within minutes

    • Tachycardia, nervousness and muscle tremors

    • Monitor v/s prior to, during, and after treatment


    Asthma10
    ASTHMA

    Anticholinergic medications

    • Prevent bronchoconstriction

    • Ipratropium bromide (Atrovent), Tiotropium bromide (Spriva)

    • Administered by MDI/inhaler

    • Act more slowly than adrenergic stimulants


    Asthma11
    ASTHMA

    Systemic Corticosteroids

    • Solu-Medrol, Prednisone

    • very potent and effective anti-inflammatory

    • alleviate symptoms, improve airway function

    • initially used – inhaled form  side effect thrush

    • side effects


    Asthma12
    ASTHMA

    Long-term medications

    Methylxanthines -Theophylline

    • Relaxes bronchial smooth muscle

    • Monitor serum theophylline levels (10-20ug/mL)

      Mast Cell Stablizers

    • Cromolyn sodium(Intal), nedrocromil(Tilade)

    • Decreases inflammation, prevents bronchospasm effects

    • Monitor for coughing, skin rash, unpleasant taste


    Asthma13
    ASTHMA

    Leukotriene Modifiers

    • Montelukast (Singulair), zafirlukast (Accolate)

    • Oral medications – reduces the inflammatory response in asthma, improves lung function

    • Affects the metabolism and secretion of other medication – warfarin, theophylline

    • May cause liver toxicity

    • Administer with meals


    Asthma14
    ASTHMA

    Management of Exacerbations

    • Early treatment and education

    • Quick – acting beta 2 adrenergic agonist

    • Systemic corticosteroids’

    • Oxygen supplementation

    • Antibiotics

    • Peak Flow Monitoring


    Asthma15
    ASTHMA

    Peak expiratory flow monitoring

    • measures the highest airflow during a forced expiration

    • establishes the patient’s personal best or normal PERF

    • value is used to evaluate the severity of airway obstruction

    • Traffic signals are used for simplicity –

      green (80 to 100%)

      yellow 50-80%

      red 50 % or less


    Asthma16
    ASTHMA

    Nursing management – depends on severity of symptoms

    • Acute asthma attacks cause – fear as breathing becomes more difficult  hypoxemia

    • Priority during an attack – improve airway clearance and reduce fear and anxiety

    • Teach about prevention of future attacks and home management


    Asthma17
    ASTHMA

    • Ineffective airway clearance

    • Anxiety

    • Community based - care


    Status asthmaticus
    STATUS ASTHMATICUS

    • Severe /persistent asthma that does not respond to routine treatment

    • Without aggressive therapy  respiratory failure

    • Attacks can occur with little or no warning  can progress rapidly to asphyxiation


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