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Respiratory Module C.O.P.D.. COPD - overview COPD? – Chronic Obstructive Pulmonary Disease COLD? – Chronic Obstructive Lung Disease Broad classifications.

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Presentation on theme: "Respiratory Module C.O.P.D.. COPD - overview COPD? – Chronic Obstructive Pulmonary Disease COLD? – Chronic Obstructive Lung Disease Broad classifications."— Presentation transcript:

1 Respiratory Module C.O.P.D.

2 COPD - overview COPD? – Chronic Obstructive Pulmonary Disease COLD? – Chronic Obstructive Lung Disease Broad classifications of disease

3 COPD Characterized by – airflow limitation – Irreversible – Dyspnea on exertion – Progressive – Abn. inflammatory response of the lungs to noxious particles or gases

4 Pathophysiology Noxious particles of gas  Inflammatory response  – (occurs throughout the airways, parenchyma and pulmonary vasculature) Narrowing of airway

5 Pathophysiology Injury  Repair Injury  repair Injury  Repair Injury  repair  scar tissue  – Narrowing of lumen

6 Pathophysiology Inflammation  Thickening of the wall of the pulmonary capillaries (Smoke damage & inflammatory process)

7 COPD Includes – Emphysema – Chronic bronchitis Does not include – Bronchiectasis – Asthma

8 COPD - FYI COPD 4th leading cause of death in the US 12 th leading cause of disability Death from COPD is on the rise while death from heart disease is going down

9 COPD Risk Factors for COPD Exposure to tobacco smoke – 80-90% of COPD Passive smoking Occupational exposure Air pollution

10 COPD risk factors #1 – Smoking Why is smoking so bad?? – ↓ scavenger cell ability – ↓ cilia function – Irritates goblet cells & Mucus glands  ↑ mucus production

11 Chronic Bronchitis Disease of the airway Definition: – cough + sputum production – > 3 months – 2 consecutive years

12 Chronic Bronchitis Pathophysiology Pollutant irritates airway  Inflammation +  secretion of mucus   goblet cells +  mucus secreting glands +  Mucus  ciliary function

13 Chronic Bronchitis Plugs become areas for bacteria to grow and chronic infections which increases mucus secretions and eventually, areas of focal necrosis and fibrosis

14 Chronic Bronchitis Bronchial walls thicken – Bronchial Lumen narrows – Mucus plugs airway Alveoli/bronchioles become damaged ↑ alveolar macrophages  ↑ susceptibility to LRI

15 What do you think? Exacerbation of Chronic bronchitis is most likely to occur during? A.Fall B.Spring C.Summer D.Winter

16 Emphysema Pathophysiology Affects alveolar membrane – Destruction of alveolar wall – Loss of elastic recoil – Over distended alveoli

17 Emphysema Pathophysiology Over distended alveoli  – Damage to adjacent pulmonary capillaries –  dead space – Impaired passive expiration  Impaired gas exchange

18 Emphysema Impaired gas exchange – impaired expiration Hypoxemia  CO2  Hypercapnia Respiratory acidosis

19 Emphysema Damaged pulmonary capillary bed –  pulmonary pressure  –  work load for right ventricle  – Right side heart failure (due to respiratory pressure)  – Cor Pulmonale

20 COPD Compare and contrast Chronic Bronchitis is a disease of the ___________? – Airway Emphysema is a disease affecting the ___________? – Alveoli

21 C.O.P.D. Risk factors, S&S, treatment, Dx, Rx - same for Chronic Bronchitis & Emphysema

22 C.O.P.D. Clinical Manifestation (primary) 1.Cough 2.Sputum production 3.Dyspnea on exertion (Secondary) Wt. loss Resp. infections Barrel chest

23 C.O.P.D. Nrs. Assessment Risk factors Past Hx / Family Hx Pattern of development Presence of comobidities Current Tx Impact

24 C.O.P.D. Diagnostic exams/procedures Pulmonary function test – Tidal Volume  – Functional residual  – Spirometry / FEV (force of expired vol.) 

25 C.O.P.D. Diagnostic exams/procedures Bronchodilator reversibility test – Check FEV – Give Bronchodilator – If improved FEV = Asthma – If no improvement FEV = COPD

26 ABG’s – Baseline PaO 2 Rule out other diseases – CT scan – X-ray

27 C.O.P.D. Medical Management Risk reduction – Smoking cessation! (The only thing that slows down the progression of the disease!)

28 C.O.P.D. Rx. therapy Primary Bronchodilators Corticosteriods Secondary Antibiotics Mucolytic agents Anti-tussive agents

29 Bronchodilators Action: – Relieve bronchospasms – Reduce airway obstruction –↑ ventilation Route – Metered-dose inhaler – Nedulizer – Oral

30 Bronchodilators Frequency – Regularly throughout the day – & PRN – Prophylactically

31 Bronchodilators Examples – Albuterol (Proventil, Ventolin, Volmax) – Metaproterenol (Alupent) – Ipratropium bromide (Atrovent) – Theophylline (Theo-Dur)* * Oral

32 Glucocorticoids Action – Potent anti-inflammatory agent Route – Inhaled – Systemic (oral or intravenous)

33 Endocrine Flashback Which of the following is an iatrogenic event secondary to prolonged use of corticosteroid medications? A.SIADH B.Diabetes Insipidus C.Cushing disease D.Addison’s disease E.Acromegaly

34 What electrolyte imbalance is assoc with Cushing Syndrome? A.Hypercalcemia B.Hypocalcemia C.Hypernatremia D.Hyponatremia E.Hyperkalemia F.Hypokalemia

35 Corticsteriods S/E – Cushing Moon face Na+ & H20 retention – Never discontinue abruptly

36 What affect do corticosteroids have of blood sugar levels?

37 Glucocorticoids Examples – Prednisone – Methyprednisone – Beclovent

38 C.O.P.D. Medical Management Treatment – O2 When PaO2 < 60 mm Hg – Pulmonary rehab Breathing exercises Pulmonary hygiene

39 Nursing Management Impaired gas exchange Ineffective airway clearance Ineffective breathing patterns Activity intolerance Deficient knowledge about self-care Ineffective coping

40 Nursing Management Impaired gas exchange – Bronchodilators – Corticosteroids – Monitor for side effects – Measure FEV (force of expired volume) – Assess dyspnea – Smoking cessation

41 Nursing Management Ineffective airway clearance – Eliminate pulmonary irritants – Directed cough – Chest physiotherapy – Fluids – Aerosol mists

42 Nursing Management Ineffective breathing patterns – Teach and encourage breathing exercises…

43 Nursing Management Breathing exercises – (usually have shallow, rapid, inefficient breathing) – Diaphragmatic breathing  ↓rate ↑ventilation ↑expelled air – Pursed lip breathing Slows respiration Prevents collapse of small airways Helps control rate and depth Relax (↓ anxiety)

44 Nursing Management Activity intolerance – Activity pacing More fatigued in AM Plan activities for “best times” – Physical conditioning Exercise training –↑ tolerance –↓ dyspnea –↓ fatigue Graded exercise Regular vs. sporadic

45 Nursing Management Deficient knowledge about self-care – ↑participation (ĉ ↑ improvement) – Coordinate diaphragmatic breathing with activities – Avoid fatigue – Fluids always available

46 Knowledge Deficit O2 therapy – Flow rate – # hours required – No smoking – Regular blood oxygenation levels – Regular ABG’s

47 Knowledge Deficit Set realistic goals Modify life style Avoid temperature extremes – Heat  ↑ O 2 demand – Cold  ↑ bronchospasms

48 Nursing Management Ineffective coping – Set realistic goals – Listen – Empathy – Refer

49 C.O.P.D. Nursing Management Imbalanced Nutrition: Less than Body requirement – (frequently weight loss and protein breakdown) – Monitor weight –↑ Protein – Nutritional supplements

50 Question? A patient is getting discharged from a SNF facility. The patient has a history of severe COPD and PVD. The patient is primarily concerned about their ability to breath easily. Which of the following would be the best instruction for this patient? A. Deep breathing techniques to increase O2 levels. B.Cough regularly and deeply to clear airway passages. C.Cough following bronchodilator utilization D.Decrease CO2 levels by increase oxygen tank output during meals.

51 Bronchiectasis Pathophysiology Chronic, irreversible, dilation of the bronchi and bronchioles Inflammatory process  Damage of bronchial wall  Permanently distended

52 Bronchiectasis Pathophysiology – Form sacs  – Secretion pool  – Infections

53 Bronchiectasis Etiology 2 nd chronic disorder Pulmonary infection Aspiration Bronchus obstruction Genetic disorder – Cystic fibrosis

54 Bronchiectasis Clinical Manifestations Recurrent LRI Cough Sputum – Copious (>200ml) – Purulent – Foul smelling Auscultation – Wheezes – Crackles

55 Bronchiectasis If wide spread  – Dyspnea Clubbing of the fingers   pulmonary blood pressure  Cor pulmonale

56 Bronchiectasis Dx S&S Sputum cultures – r/o TB CT*

57 Bronchiectasis Tx Bronchodilators Mucolytic agents Antibiotics Surgery O2 – If hypoxemia Postural drainage Chest physiotherapy Smoking cessation

58 Asthma Pathophysiology Characterized by intermittent airway obstruction In response to variety of stimuli  – Epithelial lining of the airway respond by becoming inflamed and edematous – Bronchospasms – Secretions increase in viscosity

59 Asthma Pathophysiology The airway hyper-responsiveness, mucosal edema &  mucus production leads to Recurrent episodes of symptoms – Cough – Chest tightness – Wheezing – dyspnea

60 Asthma What is the strongest predisposing factor for asthma? A.Smoking B.Family history C.Allergy D.Having a weird middle name

61 Asthma Pathophysiology Mast-cells play a key role in the inflammatory process Alpha– adrenergic receptors trigger broncho- constriction

62 What is the action of a mast-cell stabilizer A.Reduces histamine release B.Increases the effectiveness of the white blood cells C.Increase WBC production D.Bronchodilatation

63 Thought question? Why is Asthma not considered a form of C.O.P.D? A.Smoking is not a risk factor B.It is not irreversible C.It doesn’t start with the letter “C” D.It is not a chronic disease E.It is not an obstructive disease

64 Asthma S&S Primary Cough Dyspnea Wheezing – Expiratory – Nasal flaring

65 Asthma Assessment & Dx History Co-mobid conditions – Gastro-esophageal reflux

66 Asthma During an Acute episode Respiratory rate – Increased (initially)  CO2? – Decreased  – Resp. alkalosis – Tired  – Decreased Resp. rate CO2 ? – Increased  – Resp acidosis

67 Asthma O2 Sats? – Decreased – Cyanosis Heart rate – Increased Blood Pressure – Increased Anxious, feeling of impending doom!

68 Asthma Prevention Manipulate known triggers – Stress – Pollen Exercise

69 Asthma Rx therapy 2 general classes of asthma medications 1.Quick-relief 2.Long-acting Because of the underlying pathology of asthma is inflammation, controlled primarily with anti- inflammatory meds

70 Asthma Rx therapy Bronchodilators – Aminophylline Anticholinergics – Atropine Sulfate – Atrovent Corticosteriods – Prednisone – Decreased inflammation Mucolytic agents – Acetylcysteine

71 Asthma Diet – Fluids Activity – Rest periods – Relaxation techniques – Not overexert self – Sit down and sip warm water

72 Status Asthmaticus Pathophysiology – Attack lasting > 24 hours – Do not respond to normal treatment

73 The term “pink puffer” refers to the client with which of the following conditions? A.ARDS B.Asthma C.Chronic obstructive bronchitis D.Emphysema

74 A 66 year old client has marked dyspnea at rest, is thin and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which disease? A.Asthma B.Chronic Bronchitis C.Emphysema

75 It’s highly recommended that clients with asthma, chronic bronchitis and emphysema have Pneumovax and flu vaccinations for which of the following reasons?

76 A.All clients are recommended to have these vaccines B.These vaccines produce bronchodilation and improve oxygenation C.These vaccines can reduce tachypnea D.Respiratory infections can cause severe hypoxia and possible death in these clients

77 Exercise has which of the following effects on clients with asthma, chronic bronchitis and emphysema? A.It enhances cardiovascular fitness B.It improves respiratory muscle strength C.It reduces the number of acute attacks D.It worsens respiratory function and is discouraged

78 Clients with Chronic Obstructive Bronchitis are given diuretics. Which of the following best explains why? A.Reducing fluid volume reduces oxygen demand B.Reducing fluid volume improves the clients mobility C.Reducing fluid volume reduces sputum production D.Reducing fluid volume improves respiratory function

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