1. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 is the result of these pathologic changes. Increased pulmonary artery pressure may cause right- sided heart failure (cor pulmonale).

2. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Changes in Alveolar Structure with Emphysema

3. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Chest Wall and Chest Wall Changes with Emphysema

4. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Typical Posture of a Person with COPD

5. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors for COPD Tobacco smoke causes 80-90% of COPD cases! Passive smoking Occupational exposure Ambient air pollution Genetic abnormalities –Alpha 1 -antitrypsin

6. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 occur in airways. Substances activated by chronic inflammation damage the parenchyma. Inflammatory response causes changes in pulmonary vasculature.

7. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of Patients with COPD: Assessment Health history Inspection and exam findings See Chart 24-2 and Chart 24-3 Review of diagnostic tests

8. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of Patients with COPD: Diagnosis Impaired gas exchange Impaired airway clearance Ineffective breathing pattern Activity intolerance Deficient knowledge Ineffective coping

9. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Collaborative Problems Respiratory insufficiency or failure Atelectasis Pulmonary infection Pneumonia Pneumothorax Pulmonary hypertension

10. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

11. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

12. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Improving Activity Tolerance Focus on rehabilitation activities to improve ADLs and promote independence. Pacing of activities Exercise training Walking aids Use a collaborative approach.

13. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Interventions Set realistic goals. Avoid extreme temperatures. Enhance coping strategies. Monitor for and manage potential complications.

14. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

15. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question COPD is the ____ leading cause of death in the United States. a.First b.Second c.Third d.Fourth

16. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 mucus. Mucus-secreting glands and goblet cells increase in number. Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucus may plug airways. Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes. The patient is more susceptible to respiratory infections.

17. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Pathophysiology of Chronic Bronchitis

18. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Asthma A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production Inflammation leads to cough, chest tightness, wheezing, and dyspnea. The most common chronic disease of childhood Can occur at any age Allergy is the strongest predisposing factor.

19. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Pathophysiology of Asthma

20. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Medications Used for Asthma Quick-relief medications See Table 24-2 –Beta 2 -adrenergic agonists –Anticholinergics Long-acting medications See Table 24-4 –Corticosteroids –Long-acting beta 2 -adrenergic agonists –Leukotriene modifiers

21. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is a methylxanthine bronchodilator? a.Aminophylline b.Atrovent c.Maxair d.Proventil

22. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples of Metered-Dose Inhalers and Spacers

23. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Teaching The nature of asthma as a chronic inflammatory disease Definition of inflammation and bronchoconstriction Purpose and action of each medication Identification of triggers and how to avoid them Proper inhalation techniques How to perform peak flow monitoring How to implement an action plan When and how to seek assistance

24. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Using a Peak Flow Meter