1. Chronic obstructive pulmonary disease (COPD) Dr. Walaa Nasr Lecturer of Adult Nursing Second year

2. COPD Out lines Out lines What is the COPD? What is the COPD? Overview Overview Causes of COPD Causes of COPD Symptoms of COPD Symptoms of COPD What's the difference between COPD and asthma? What's the difference between COPD and asthma? Diagnostic tests needed for COPD Diagnostic tests needed for COPD Medical management of COPD Medical management of COPD Preventive measures Preventive measures Nursing intervention Nursing intervention Outlook and Prognosis Outlook and Prognosis

3. COPD Definition COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time. COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

4. COPD Overview

5. In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual, which tends to clog them.

6. COPD Causes Smoking Smoking Air pollution Air pollution genetic (hereditary) risk genetic (hereditary) risk

7. COPD Symptoms Productive cough Breathlessness Chest infection Other symptoms of COPD can be more vague, weight loss, tiredness and ankle swelling.

8. Difference between COPD and Asthma In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are chronic (persistent). Treatment to open up the airways, is therefore limited. In asthma there is inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well. COPD is more likely than asthma to cause a chronic (ongoing) cough with sputum.

9. Difference between COPD and asthma (cont … ) Night time waking with breathlessness or wheeze is common in asthma and uncommon in COPD. Night time waking with breathlessness or wheeze is common in asthma and uncommon in COPD. COPD is rare before the age of 35 whilst asthma is common in under-35. COPD is rare before the age of 35 whilst asthma is common in under-35.

10. COPD COPD Diagnostic tests Symptoms Physical examination Sample of sputum Chest x-ray High-resolution CT (HRCT scan) Pulmonary function test (spirometery) Arterial blood gases test Pulse oximeter

12. COPD COPD Medical management Give antibiotics to treat infection Give bronchodilators to relieve bronchospasm, reduce airway obstruction, mucosal edema and liquefy secretions. Chest physiotherapy and postural drainage to improve pulmonary ventilation. Proper hydration helps to cough up secretions or tracheal suctioning when the patient is unable to cough. Steroid therapy if the patient fails to respond to more conservative treatment.

13. COPD COPD Medical management (cont … ) Stop smoking Stop smoking Oxygenation with low concentration during the acute episodes Oxygenation with low concentration during the acute episodes In asthma adrenaline ( epinephrine) SC if the bronchospasm not relieved. In asthma adrenaline ( epinephrine) SC if the bronchospasm not relieved. Aminophylins IV if the above treatment does not help. Aminophylins IV if the above treatment does not help. IV corticosteroids for patients with chronic asthma or frequent attack. IV corticosteroids for patients with chronic asthma or frequent attack. Sedative or tranquilizers to calm the patient. Sedative or tranquilizers to calm the patient. Increase fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation. Increase fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation. Intubations and mechanical ventilation if there is respiratory failure. Intubations and mechanical ventilation if there is respiratory failure.

14. To prevent irritation and infection of the airways, instruct the patient to: To prevent irritation and infection of the airways, instruct the patient to: Avoid exposure to cigarette, pipe, and cigar smoke as well as to dusts and powders. Avoid exposure to cigarette, pipe, and cigar smoke as well as to dusts and powders. Avoid use of aerosol sprays. Avoid use of aerosol sprays. Stay indoors when the pollen count is high. Stay indoors when the pollen count is high. Stay indoors when temperature and humidity are both high Stay indoors when temperature and humidity are both high COPD Preventive measures

15. Use air conditioning to help decrease pollutants and control temperature Avoid exposure to persons known to have colds or other respiratory tract infection Avoid enclosed, crowded areas during cold and flu season. Obtain immunization against influenza and streptococcal pneumonia. COPD Preventive measures (cont … )

16. To ensure prompt, effective treatment of a developing respiratory infection, instruct the patient to do the following:- To ensure prompt, effective treatment of a developing respiratory infection, instruct the patient to do the following:- Report any change in sputum color character, increased tightness of the chest, increased dyspnea, or fatigue. Report any change in sputum color character, increased tightness of the chest, increased dyspnea, or fatigue. Call the physician if ordered antibiotics do not relieve symptoms within 24 hours. Call the physician if ordered antibiotics do not relieve symptoms within 24 hours.

17. Nursing intervention COPD Nursing intervention Assessment Assessment History History Patient's environment Patient's environment Work history, exercise pattern, smoking habits Work history, exercise pattern, smoking habits The onset & development of symptoms The onset & development of symptoms Sleeping positions Sleeping positions

18. Nursing intervention (cont … ) COPD Nursing intervention (cont … ) Physical examination Signs of heavy smokers Observe for clubbing Distended neck vein on expiration The presence of barrel chest Observe for abdominal breathing The use of pursed lips breathing and chest movement Auscultate the chest& listen for musical wheezes characteristics of chronic bronchitis

20. Nursing intervention (cont … ) COPD Nursing intervention (cont … ) review the results of diagnostic procedure: Arterial blood gases Pulmonary function tests X-ray films Nursing diagnosis Ineffective breathing pattern related to increase need of O2 Ineffective airway clearance related to excessive accumulation of secretions Impaired gas exchange related to impaired expiration &co2 retention

21. Nursing intervention (cont … ) COPD Nursing intervention (cont … ) Activity intolerance related to inadequate oxygenation High risk for ineffective individual coping related to chronic disease, its effects& its treatment High risk for altered health maintenance related to insufficient knowledge of prevention, identification and treatment of respiratory complication of COPD