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COPD It Takes Your Breath Away. Patti J. Pagel, RN, BSN Alverno College MSN Program April, 2007 patti.pagel@aurora.org. Self-Study Tutorial Guide Instruction Page. Click on to go back to previous slide Click on to go to the next slide

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copd it takes your breath away

COPDIt Takes Your Breath Away

Patti J. Pagel, RN, BSN

Alverno College

MSN Program

April, 2007

patti.pagel@aurora.org

self study tutorial guide instruction page
Self-Study Tutorial GuideInstruction Page
  • Click on to go back to previous slide
  • Click on to go to the next slide
  • Click on to return to objectives
  • Click on True/False and learn the correct answer when presented in a slide
  • Click on Answer for multiple choice to check for correct answer
  • Click here to go back to review slides
  • Click on website linkfor further information
welcome main menu click on subject to navigate to
Welcome!Main MenuClick on subject to navigate to:

Or click on forward arrow to go to next slide

Objectives

Nursing

Outcomes

Pathophysiology

Interventions

Respiratory

Review

Patho Quiz

Case Study

Respiratory

Quiz

Signs & Symptoms

References

intended audience
Intended Audience
  • This self-study tutorial on Chronic Obstruction Pulmonary Disease is intended for the following people:
          • Registered Nurses
          • Medical Assistants
          • Anyone interested in learning

about COPD

tutorial objectives
Tutorial Objectives
  • Review respiratory system anatomy.
  • Increase understanding of the pathophysiology of COPD.
  • Recognize signs and symptoms of COPD.
  • Identify treatment options:
      • Non-pharmaceutical nursing interventions
      • Pharmaceutical interventions
nursing outcomes
Nursing Outcomes:
  • Respiratory Status: Ventilation

- movement of air in and out of lungs

  • Respiratory Status: Airway Patency

- open, clear tracheobronchial passages

  • Knowledge: Medications

- extent of understanding conveyed about the safe use of medication

Source: (Moorhead et al 2004)

Microsoft clipart

let s review respiratory anatomy
Let’s Review: Respiratory Anatomy
  • Upper Respiratory Tract:

Mouth, nose, throat (pharynx), larynx, trachea

  • Lower Respiratory Tract:

Lungs, bronchi, alveoli

  • Medulla Oblongata

Controls inspiration/expiration

Microsoft clipart

anatomy review
Anatomy Review

Used with permission: webschoolsolutions, 2007

respiratory review let s take a breath together
Respiratory ReviewLet’s Take a Breath Together:
  • Air is warmed and humidified.
  • Cilia filter out dust particles.
  • Macrophages destroy germs.
  • Air goes to L and R bronchi.
  • Then to the bronchioles.
  • Through to the Alveoli.
  • Oxygen and CO2 exchange

takes place.

Used with permission: Jensen M.S., Webanatomy 2007

respiratory review now your breath is
Respiratory Review:Now your Breath is…
  • Alveoli fill with air.
  • Oxygen diffuses thru alveoli walls.
  • Oxygen diffuses to Capillaries

and bloodstream.

  • Hemoglobin for transport of

oxygen.

  • Oxygen to the heart and

to the body.

Used with permission: Jensen, M.S., Webanatomy (2007).

respiratory review let your air out
Respiratory ReviewLet your air out…
  • Hemoglobin frees oxygen.
  • O2 to cells.
  • CO2 is the waste product.
  • Veins return CO2 to heart.
  • Heart pumps CO2 to lungs.
  • CO2 passes alveoli to be exhaled

Use with permission: Jensen, M.S., Webanatomy (2007)

respiratory quiz
Respiratory Quiz
  • Respiratory Assessment:

Understanding the anatomy of the lungs, where does the exchange of oxygen and CO2 occur:

A. Bronchioles

B. Aveoli

C. Bronchial Tubes

Click on underlined best answer.

respiratory quiz13
Respiratory Quiz:
  • Respiratory Assessment:

What part of the body controls inspiration and expiration?

A. Pituitary Gland

B. Sympathetic Nervous System

C. Medulla Oblongata

Click on underlined best answer.

what is copd chronic obstructive pulmonary disease
What is COPD?Chronic Obstructive Pulmonary Disease

COPD is a group of respiratory disorders characterized by chronic, recurrent, irreversible obstruction of airflow in the pulmonary airways not fully reversible with inhaled bronchodilators. (Porth, 2005) (Punturieli, 2007)

chronic obstructive pulmonary disease copd
Chronic Obstructive Pulmonary Disease (COPD)

FACTS YOU SHOULD KNOW:

  • FOURTH leading cause of death in United States.
  • COPD refers to two lung diseases:

Chronic Bronchitis & Emphysema.

  • Smoking is a primary risk factor.
  • Air pollution, second-hand smoke, history of childhood respiratory infections and heredity are other causes.
  • Female smokers are almost 13 times as likely to die from COPD than women who have never smoked.
  • 11.4 million U.S. adults affected.
  • $37.2 billion cost to nation.
  • Important cause of hospitalization in our aged population.

Source:American Lung Association Fact Sheet August 2006

chronic obstructive pulmonary disease fact you might not know
Chronic Obstructive Pulmonary DiseaseFact you might not know…

COPD patients most likely have been smoking 20 cigarettes per day for 20 or more years before they even get symptoms (Snider, 2006).

Microsoft clipart

what causes copd
What Causes COPD?

What do youthink are the two causes of COPD?

Find the two causes- click on word

Cigarette Smoking Factory Work

ObesityCancer

DiabetesStroke

Alcohol AbuseInactivity

Coronary Heart Disease

Alpha1-antitripsin Deficiency

Click HERE to learn more about COPD.

pathogenesis of copd
Pathogenesis of COPD

Inflammation bronchial walls Cause

airway

Fibrous bronchial walls obstruction &

problems

Hypertrophy of submucosal glands with

ventilation

Hypersecretion of mucus &

perfusion

Loss of elastic lung fibers and alveoli tissue

(Porth, 2005)

types of copd
Types of COPD:
  • Chronic Bronchitis ----- -Obstruction of small airway

-Inflammation of major & small airways

  • Emphysema

-Enlargement of air spaces

-Destruction of tissues

  • Alpha1- antitrypsin deficiency

-inherited disorder

-protective material produced in liver and transported to lungs to help combat inflammation

-leads to destruction of alveoli

(Porth, 2005)

characteristics of chronic bronchitis
Characteristics of: Chronic Bronchitis
  • Cough with phlegm
  • Shortness of breath
  • Exercise Intolerance
  • Expiratory phase of respiration long
  • Wheezes and Crackles on auscultation
  • Inability to maintain stable arterial blood gases
  • Hypoxemia

(Porth, 2005)

characteristics of chronic bronchitis21
Characteristics of:Chronic Bronchitis
  • Doesn’t strike suddenly
  • Damage occurs before patients seek treatment
  • Pulmonary hypertension
  • Right heart failure with peripheral edema

(Porth, 2005)

chronic bronchitis diagnosis
Chronic Bronchitis Diagnosis
  • Mucus producing cough most days of the month, three months of a year for two consecutive years (ALA).

Microsoft Clipart

characteristics emphysema
Characteristics: Emphysema
  • Dyspnea, slowly progressive
  • Abnormal Arterial Blood Gases
  • Use accessory muscles
  • Weight loss
  • Sputum production in morning, scant
  • Cough- minimal
  • Loss of lung elasticity
  • Destruction of alveoli walls and capillary beds

(Porth, 2005)

emphysema diagnosis
Emphysema Diagnosis

Careful history and physical examination

Pulmonary function studies

Forced Expiratory Volumes

Chest radiographs

Laboratory tests

Microsoft clipart

copd let s review
COPD is the fourth leading cause of death in the United States.

TRUE

FALSE

Heredity is the most common cause of COPD

TRUE

FALSE

Click hereto proceed to next slide

COPD- Let’s Review
pathophysiology autonomic nervous system respiratory centers
Pathophysiology Autonomic Nervous System Respiratory Centers:

MEDULLARY

&

PONS

Ventilation

Stretch

Receptors

Irritant

Receptors

Central

Chemoreceptor

Peripheral

Chemoreceptor

Monitor

Stretch

of

Lungs &

Chest Wall

Involved

With

Reflexes

Causing

Coughing &

Sneezing

Respond to

Arterial PCO2

Respond to

Arterial

PO2 & PCO2

(Freudenrich, 2007)

factors that influence the respiratory centers
Factors that Influence the Respiratory Centers:

Craig C. Freudenrich, Ph.D..  "How Your Lungs Work".  October 06, 2000  http://health.howstuffworks.com/lung.htm  (April 12, 2007)

Carbon Dioxide:

Central Receptor

Monitors CO2

Concentration in CSF

Hydrogen Ion (pH):

Peripheral & Central

Sensitive to pH of

Blood and CSF

Oxygen:

Peripheral Receptor

Monitors O2 concentration

of blood

 Hydrogen Ion=

 Rate and Depth

Breathing

 oxygen

Concentration=

 Rate and Depth

Breathing

 CO2 =

 Rate and Depth

Breathing

the single most important driver of ventilation is co 2
The single most important driver of ventilation is CO2

But can be deadly for the COPD Patient

Microsoft clipart

CO2

CO2

CO2

CO2

CO2

CO2

CO2

CO2

CO2

example of receptors at work
Example of receptors at work:

You administer high flow supplemental oxygen to a patient with COPD and the patient stops breathing.

What Happened to your patient?

you removed his drive to breathe
You removed his drive to breathe!

Specifically, patients with COPD retain CO2 chronically. Administering oxygen removes the central

chemoreceptor drive to breathe. The central chemoreceptor is not sensitive to small oxygen changes like when a person breathes deep but high flow oxygen administration extinguished the stimulus to breathe.

arterial blood gases abg s snap shot of your patient s oxygen status
Arterial Blood Gases (ABG’s)SNAP SHOT OF YOUR PATIENT”S OXYGEN STATUS

COPD PATIENT- 3L O2

Normal ABG Results Abnormal ABG Results

pH 7.35-7.45 pH 7.32

PaCO2 35-45 PaCO2 69

HCO3 22-26 HCO3 32

PaO2 80-100 PaO2 86

The abnormal ABG finding indicates your patient is retaining CO2.

What we don’t know just from the ABG result is if your patient

is compensating or uncompensated. A complete history needs to

be obtained.

(Perry & Potter, 2006)

pathophysiology copd
Pathophysiology COPD
  • Emphysema type of COPD:
        • Walls between many of the air sacs are destroyed leading to few large air sacs.
        • These large air sacs have less surface area for O2 and CO2 exchange.
        • Poor exchange of O2 and CO2 causes

shortness of breath.

pathophysiology copd33
Pathophysiology COPD
  • Bronchitis type of COPD:
        • Airways inflamed and thickened
        • Increase number & size of mucus producing cells
        • Excessive mucus production
        • Coughing to remove mucus
        • Difficulty getting air in & out

Used with permission: Jensen, M.S., Webanatomy (2007).

pathophysiology copd34
Pathophysiology COPD

Take a look at the next slide and note where the oxygen exchange takes place in the lungs.

o 2 and co 2 exchange
O2 and CO2 Exchange

Used with permission: http://www.pbs.org/wgbh/nova/everest/exposure/body.html

pathophysiology copd36
Pathophysiology COPD

Now take a look at the comparison of a healthy lung and a COPD emphysema lung.

slide37

With permission Copyright 2007 American Lung Association

For more information about the American Lung Association or to support the work it does, call 1-800-LUNG-USA (1-800-586-4872) or log on to www.lungusa.org.

pathophysiology copd38
Pathophysiology COPD

Probably a good time to share with you the…

WISCONSIN TOBACCO

QUIT LINE:

1-800-QUIT-NOW

(1-800-784-8669)

(UW WI Madison, 2005)

Microsoft clipart

pathophysiology quiz let s see how you are doing
Pathophysiology QuizLet’s see how you are doing-

Which type of COPD leads to destruction of the surface area of the alveoli?

Chronic Bronchitis or

Emphysema

pathophysiology quiz
Pathophysiology Quiz

What causes the central chemoreceptor in the medulla to signal the respiratory center to increase the rate and depth of respirations?

A. Low oxygen in blood

B. High oxygen in blood

C. High CO2 level in blood

D. Gee, I need to review. CLICK HERE

just checking in with you
Just checking in with you-

How are you doing?

Need to review more?

Ready to move on?

You are doing very well.

We’re almost finished!

Microsoft clipart

copd signs and symptoms review
COPD- Signs and SymptomsReview…

Chronic Cough-Major Factor in seeking care.

Exercise intolerance-Fatigue

Shortness of breath-At rest or activity

(Kessenich & Dayer-Berenson, 2007)

what happens when your patient has an exacerbation of copd
What happens when your patient has an Exacerbation of COPD?

These patients have sustained worsening of their usual state of health. They will exhibit:

Worsening breathlessness

Increased cough

Increased sputum production (toyellow/green)

(Bellamy, D. 2006)

what triggers a copd exacerbation
What triggers a COPD Exacerbation?

INFECTION

AIR POLLUTION

COLD WEATHER

Weakened Immune System

copd patients
COPD Patients
  • PINK PUFFER: early disease Emphysema
    • Over ventilate to maintain relatively normal ABG’s until late in disease
    • Red face
  • BLUE BLOATER: Chronic Bronchitis
    • Bronchial secretions and airway obstruction cause poor ventilation and perfusion; unable to compensate leading to hypoxia and cyanosis
    • Clubbing
    • Circumoral cyanosis

(Porth, 2005)

Microsoft Clipart

barrel chest what s this
Barrel Chest- What’s this?

COPD patients chest often looks barrel shaped.

Why?

These patients have a loss of lung elasticity. Airways collapse during expiration because pressure in lung tissue exceeds airway pressure. Air gets trapped causing increase in anteroposterior dimensions of the chest (Porth, 2005).

Simply:

Their lungs are chronically over inflated with air.

Microsoft clipart

pursed lip breathing what s this
Pursed Lip Breathing- What’s this?

COPD patients purse their lips to breath.

WHY?

Pursing your lips increases the resistance to the outflow of air. It helps to prevent airway collapse by increasing pressure (Porth, 2005).

Simply:

Pucker up.

Try to blow air out.

Feel the resistance?

Microsoft clipart

signs and symptoms of co 2 retainers
Signs and Symptoms of CO2 RETAINERS

Labored Breathing

Feeling of Air Hunger

Nausea

Confusion

Dizziness

Headache

nursing interventions non pharmaceutical
Nursing InterventionsNon Pharmaceutical

SMOKING CESSATION

AVOID EXPOSURE TO RESPIRATORY INFECTIONS

ENCOURAGE FLU & PNEUMOCOCCAL VACCINES

Microsoft clipart

nursing interventions non pharmaceutical50
Nursing InterventionsNon Pharmaceutical

POSITIONING:

Sit patient on side of bed with bed side table.

BREATHING:

Encourage pursed lip breathing.

Incentive Spirometry

DIET:

Small frequent nutritious meals

Easily swallowed food

Microsoft clipart

nursing interventions non pharmaceutical51
Nursing InterventionsNon Pharmaceutical

PULMONARY REHABILITATION

PHYSICAL CONDITIONING

SUPPORTIN PATIENT CARE COMMUNITY CARE

Microsoft clipart

nursing interventions pharmaceutical
Nursing InterventionsPharmaceutical

OXYGEN IS a drug not just something that sometimes makes the patient breathe better.

Keep oxygen saturation above 90%.

Follow physician order.

Monitor ABG’s as ordered by physician.

Dangerous side effects:

Atelectasis

Oxygen toxicity

CO2 retention(Perry & Potter, 2005)

nursing interventions pharmaceutical53
Nursing InterventionsPharmaceutical

BRONCHODILATORS

Inhaled B2-adrenergic antagonists

Anticholinergic agents- long and short acting

Inhaled corticosteroids

Oral corticosteroids

IV corticosteroids

Dangerous side effects:

Monitor blood sugars

Can increase heart rate

Patients with fungal infections should use with caution

(Perry & Potter, 2005)

nursing interventions pharmaceutical in patient care
Nursing InterventionsPharmaceutical- In patient care

GIVING SOLUMEDROL: Methylprednisolone Sodium Succinate

INDICATION FOR COPD:

Inflammation

DOSING:

40mg-125mg q 6-8 hours IV

NURSING CONSIDERATION:

Give IV slow, over one minute

Don’t discontinue abruptly

Monitor for fungal infection

Monitor blood glucose

(Perry & Potter, 2005)

nursing interventions pharmacologic
Nursing InterventionsPharmacologic

ANTIBIOTICS

Can be used to treat an acute exacerbation of COPD due to bacterial infections.

No evidence to support prophylactic use to prevent COPD exacerbation.

Nursing:

Check for patient allergies before administering antibiotic therapy.

Patient education to take all medication is important.

(Porth, 2005)

nursing interventions pharmaceutical56
Nursing InterventionsPharmaceutical

Anti-anxiety Medication

COPD patients tend to become very anxious during an exacerbation. Collaborate with the physician to assess appropriate medication for your patient.

This aspect of patient care is often times overlooked.

Microsoft clipart

nursing intervention in patient care
Nursing InterventionIn Patient Care

Often times the physician will order Solumedrol intravenously. Can you tell me what the normal dosing schedule would be for giving this drug on your unit?

  • IV Solumedrol 300mg every 2 hours
  • IV Solumedrol 60 mg every 8 hours
  • IV Solumedrol 2gm every 6 hours for 72 hours
  • IV Solumedrol 3gm every 8 hours for 48 hours

Click here to go to next slide.

nursing intervention in patient care58
Nursing InterventionIn Patient Care

Complete Respiratory Assessment

Assess Co-morbidities

Confirm allergies

Review medications

Monitor lab values: CBC, ABG’s, Lytes

Collaborate with physician

Educate patient and family

Administer IV medications as ordered

EVALUATE RESPONSE TO TREATMENT

case study mr sigh a nosis
Case Study Mr. Sigh A. Nosis

Mr. Nosis is a 64 year-old- male who presents to the ER with complaints of SOB, wheezing and fatigue. His past medical history indicates a 32-year history of smoking two packs of cigarettes a day. With only this information, what can you anticipate the ER physicians orders to include?

  • Chest x-ray, Ct scan and lasix
  • Chest x-ray, ABG’s, IV access
  • Chest x-ray, ABG’s, exercise stress test
case study mrs bronk i tis
Case Study:Mrs. Bronk I. Tis

Mrs.Tis comes to the clinic today for a follow up post hospital visit with acute exacerbation of COPD. She is a widow, elderly, frail looking woman. Which of the following concerns you?

  • Oxygen saturation is 92% after a walk in the hall with you on room air.

B. A weight loss of six pounds since her discharge four weeks ago.

this concludes the copd tutorial
This concludes the COPD Tutorial

I hope you have enjoyed and learned about COPD. You can make an impact in the lives of the patients you care for with this disabling but many times preventable disease.

Patti Pagel RN BSN

Alverno College

references
References
  • American Lung Association. (2006). Chronic obstructive pulmonarydisease fact sheet. Retrieved February 16, 2007 from http://lungusa.org.
  • Anugwom, C., & Dachs, R. (2006). Beta-blocker use in patients with COPD. American Family Physician. (74)11., p1858.
  • Bay Area Medical Information. (2006). Overview of the respiratory system. Retrieved March 7, 2007 from http://www.bami.us/Resp/COPD2.html.
  • Bellamy, D., (2006). COPD exacerbations. Practice Nurse (32)6., p35-42. Retrieved February 15, 2007 from http://web.ebscohost.com/ehost/delivery?vid=4&hid=7&sid=cef94c21-be5a-4615-a3a7-33.
  • Freudnenrich, C.C., (2007). How your lung works. Retrieved April 13, 2007 from http://health.howstuffworks.com/lung.htm/printable.
  • Goldsmith, C., (2007). Fighting for breath with COPD. Nurseweek. Retrieved March 1, 2007 from http://www.nurseweek.net.
references continued
References continued
  • Kessenich, C.R., & Dayer-Berenson, L., (2007). Polypharmacy in the elderly. Nurseweek. Retrieved March 1, 2007 from http://www.nurseweek.net
  • Moorhead, S., Johnson, M., & Maas, M., (2004). Nursing outcomes classification. Iowa outcome project (3rd ed.). St Louis, MO: Mosby.
  • Nova. How the body uses O2. Retrieved on March 19, 2007 from http://www.pbs.org/wgbh/nova/everest/exposure/body.htm.
  • Porth, C. M., (2005). Pathophysiology: Concepts of altered healthstates. (7th ed. ). Philadelphia: Lippincott, Williams & Wilkins.
  • Perry, A.G., & Potter, P. A., (2006). Clinical nursing skills andtechniques. (6th ed.). St. Louis, MO: Mosby, Elsevier.
  • Punturieri, A., Croxton, T., Weinman, G., & Kiley, J.P., (2007). The changing face of COPD. American Academy of Family Physicians. (75)3., February 1, 2007.
  • Snider, G.L., (2006). Diagnosis of chronic obstructive pulmonary disease. Uptodate. Retrieved February 12, 2007 from http://www.utdol.com.
  • University Wisconsin Madison (2005). Report: State tobacco quit line saves millions in health care costs. Retrieved April 16, 2007 from http://www.news.wisc.edu/11228.html.
illustration references
Illustration References:
  • American Lung Association website. Retrieved March 22, 2007 from www.lungusa.org.
  • Jensen, M., website. Retrieved April 12, 2007 from

http://www.msjensen.gen.umn.edu/webanatomy/default.htm.

  • Microsoft Corp. (2006). Microsoft clipart. Retrieved February 26, 2007 from www.microsoftclipart.com.
  • Nova website. Retrieved April 9, 2007 from http://ww.pbs.org/nova/teachers.
  • Rose, L., website. Retrieved March 18, 2007 from http://webschoolsolutions.com/patts/systems/ lungs.htm.
special thank you
Special thank you…

To everyone who supported the time, ideas, energy, frustrations, excitement, & trial runs to the completed project. I sincerely thank you.

Roger Pam Christine David(s)

Elizabeth Paula Georgia Kim

Nicholas Vicki Patti Debbie

Mom Kathy(s) Susanne Linda

Randy Marcia Jeanine Pat

Kris