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Management of Patients With Chronic Pulmonary Disease. COPD:. Chronic Obstructive Pulmonary Disease A disease state characterized by airflow limitation that is not full reversible (GOLD). COPD is the currently is 4 th leading cause of death and the 12 th leading cause of disability.

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Presentation Transcript
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COPD:
  • Chronic Obstructive Pulmonary Disease
  • A disease state characterized by airflow limitation that is not full reversible (GOLD).
  • COPD is the currently is 4th leading cause of death and the 12th leading cause of disability.
  • COPD 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.
pathophysiology of copd
Pathophysiology of COPD
  • Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious agents.
  • Inflammatory response occurs throughout the airways, lung parenchyma, and pulmonary vasculature.
  • Scar tissue and narrowing occurs in airways.
  • Substances activated by chronic inflammation damage the parenchyma.
  • Inflammatory response causes changes in pulmonary vasculature.
chronic bronchitis
Chronic Bronchitis
  • The presence of a cough and sputum production for at least 3 months in each of 2 consecutive years.
  • Irritation of airways results in inflammation and hypersecretion of mucous.
  • Mucous-secreting glands and goblet cells increase in number.
  • Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways.
  • Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes.
  • The patient is more susceptible to respiratory infections.
emphysema
Emphysema:
  • Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli.
  • Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion.
  • Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures.
  • Hypoxemia result of these pathologic changes.
  • Increased pulmonary artery pressure may cause right-sided heart failure (corpulmonale).
risk factors for copd
Risk Factors for COPD
  • Tobacco smoke causes 80-90% of COPD cases!
  • Passive smoking
  • Occupational exposure
  • Air pollution
  • Genetic abnormalities(2% of cases)
    • Alpha1-antitrypsin deficiency ( enzyme inhibitor that protect the lung parenchyma from injury)
clinical manifestation
Clinical Manifestation
  • 3 primary symptoms:
  • Chronic cough
  • Sputum production
  • Dyspnea on exertion
  • Wt loss
  • Barrel chest (A-P diameter/ Transverse diameter : 2/1)
  • Retraction in the supraclavicular area on inspiration
  • Shrug shoulder
  • Abdominal muscle contraction on inspiration (paradox respiration) .
medical management
Medical Management
  • Risk reduction
  • Pharmacologic therapy
  • Management of exacerbation
  • O2 therapy
  • Surgical management
  • Pulmonary rehabilitation
nursing process the care of patients with copd assessment
Nursing Process: The Care of Patients with COPD- Assessment
  • Health history
  • Inspection and examination findings
  • Review of diagnostic tests
nursing process the care of patients with copd diagnoses
Nursing Process: The Care of Patients with COPD- Diagnoses
  • Impaired gas exchange
  • Impaired airway clearance
  • Ineffective breathing pattern
  • Activity intolerance
  • Deficient knowledge
  • Ineffective coping
collaborative problems
Collaborative Problems
  • Respiratory insufficiency or failure
  • Atelectasis
  • Pulmonary infection
  • Pneumonia
  • Pneumothorax
  • Pulmonary hypertension
nursing process the care of patients with copd planning
Nursing Process: The Care of Patients with COPD- Planning
  • Smoking cessation
  • Improved activity tolerance
  • Maximal self-management
  • Improved coping ability
  • Adherence to therapeutic regimen and home care
  • Absence of complications
improving gas exchange
Improving Gas Exchange
  • Proper administration of bronchodilators and corticosteroids
  • Reduction of pulmonary irritants
  • Directed coughing, “huff” coughing
  • Chest physiotherapy
  • Breathing exercises to reduce air trapping
    • diaphragmatic breathing
    • pursed lip breathing
  • Use of supplemental oxygen
improving activity tolerance
Improving Activity Tolerance
  • Focus on rehabilitation activities to improve ADLs and promote independence.
  • Pacing of activities
  • Exercise training
  • Walking aides
  • Utilization of a collaborative approach
other interventions
Other Interventions
  • Set realistic goals
  • Avoid extreme temperatures
  • Enhancement of coping strategies
  • Monitor for and management of potential complications
patient teaching
Patient Teaching
  • Disease process
  • Medications
  • Procedures
  • When and how to seek help
  • Prevention of infections
  • Avoidance of irritants; indoor and outdoor pollution, and occupational exposure
  • Lifestyle changes, including cessation of smoking