Chronic Obstructive Pulmonary Disease

COPD is an umbrella term for two diseases which cause progressive airflow obstruction Chronic Bronchitis- Inflammation of the mucus membranes of the bronchi, causing chronic cough, increased mucus production, and narrowing of the airway. Emphysema- Enlargement of air spaces that do not return to size, causing air trapping, and hyperinflation of lung tissue. COPD is the 3 rd leading cause of death in the USA

Risk Factors of COPD Modifiable Smoking Frequent respiratory infections (May or may not be modifiable) Unmodifiable History of asthma Poor lung development in childhood Family history Alpha1-antitrypsin deficiency Gender, Race, & socioeconomic status

Diagnosis is made by... Review of past medical and family history Review and assessment of symptoms Spirometry testing to measure the FVC and FEV1 to obtain a measurement of lung obstruction X-ray and CT scan may be obtained to visualize lung changes, but not usually helpful in diagnosis ABG Oxygen saturation

Symptoms Symptoms should be assessed by asking questions such as: When did they begin? How long do they last? Does anything make them better or worse? Is there a time of day they are more prevalent? Etc... Also we need to ask questions about things clients may not think is related. Ex: recent wt loss Common symptoms of COPD are: Excessive mucus, cough, dyspnea (with or without exertion), wheezing, fatigue, weight loss

Treatments Medications may be short or long acting.  Bronchodilators: Open up airways  Corticosteroids: Decrease inflammation  Antibiotics: Decrease exacerbation with infection Oxygen Therapy to increase survival rate  Portable  Concentrator

Treatments Pulmonary Rehabilitation may be prescribed to aid in increasing the quality of life Treatment of psychological issues Surgical Interventions  LVRS  Bullectomy  Lung Transplant

Nursing Assessment Review of PMH Hx of smoking Objective Assessment: respirations, auscultation of lung sounds, oxygen saturation, use of accessory muscles, body position, weight changes Subjective assessment: do you ever feel SOB? Tired? Anxious? Depressed? Afraid?

Nursing Care Plans When planning goals for our client's be sure to set attainable goals. Also when appropriate, involve family members in care planning. Some common nursing diagnosis:  Impaired gas exchange  Activity intolerance  Imbalanced nutrition: less than body requirements  Powerlessness  Social isolation

Client Teaching Client teaching should begin upon diagnosis and follow through the entire disease process with both verbal and written information for the client. Pursed lip breathing is taught to allow more time to exhale and decrease air trapping. How to perform pursed lip breathing: 1. Relax muscles and breath in through the nose  2. Exhale through puckered lips (almost as if your going to whistle). You should be able to breath out 2x longer then the time it took you to inhale.

Client Teaching The tripod position is taught to decreased oxygen demand of the muscles and push the diaphragm up reducing the workload of breathing.  The client should lean forward while supporting their arms, making a triangle like shape with their upper body. Client's need to be taught the importance of trying to maintain in good health with nutrition, hand washing, and avoiding crowds in times of high respiratory illnesses.

Client Teaching Oxygen therapy safety is mandatory  Use oxygen as directed  Be cautious not to fall on oxygen tubing  Do not use petroleum based products on face  Do not store oxygen in a closed space  Keep oxygen away from heat and open flames Encourage cessation of smoking Proper use of medications and times to be taken Psychosocial support and referral when appropriate