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Obstructive Lung DiseaseKimberlyAugustine BSRN
Objectives
Define Obstructive Lung Disease Epidemiology Pathophysiology Identify Clinical manifestations Identify Risk factors Discuss Evaluation & Treatment
Definition Several different definitions have existed for COPD.
“A disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.”-GOLD
A group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema, chronic bronchitis, and in some cases asthma.-CDC
“Airway obstruction:most common obstructive diseases are asthma, chronic bronchitis, emphysema-McCane & Huether
Obstructive Pulmonary Disease
Obstructive Diseases
Include:
Chronic bronchitis
Emphysema
Asthma
Epidemiology
4th leading cause of death in the U. S. 12.1 million U.S. adults were estimated
to have COPD Women have exceeded men in the
number of deaths attributable to COPD 2010, $49.9 billion COPD health care
costs Worldwide leading cause of death &
disability 2020, predicted 3rd leading cause of death
Pathophysiology: Video
http://www.youtube.com/watch?v=lYW_2Rfuii8&feature=related
Obstructive Lung Disease: Emphysema
“ A condition which the lungs lose elasticity and alveoli enlarge that disrupts function”
Destruction of lung parenchyma Loss of elastic recoil Alveolar gas is trapped in expiration Gas exchange is compromised
Pathophysiology: Emphysema
Begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood.
The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.
As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath.
The lungs also lose their elasticity, which is important to keep airways open. The patient experiences great difficulty exhaling.
COPD: Emphysema
COPD: EmphysemaSigns & Symptoms
Dyspnea Little sputum production or cough Tachypnea with prolonged expiration Use of accessory muscles for ventilation Increased anteroposterior diameter of thorax (Barrel
Chest) Pierced Lips to prevent expiratory airway collapse Cardiac enlargement Hyperresonant (loud, low) sound with chest percussion
d/t hyperinflation
Obstructive Lung Disease: Chronic Bronchitis
“The presence of a mucus-producing cough three months of a year for two consecutive years without other underlying disease to explain the cough.”
Inflammation and eventual scarring of the lining of the bronchial tubes
Inflamed, infected bronchi allow for less air to flow to and from the lungs and a heavy mucus or phlegm is coughed up
Pathophysiology: Chronic Bronchitis Increased mucous production Increase in size, number goblet cells Impaired Ciliary function Bronchospasm, permanent narrowing of airways Decreased ventilation Tidal Volume Decreased Hypoventilation Hypercapnia
COPD: Chronic Bronchitis
COPD: Chronic BronchitisSigns & Symptoms
Wheezing and shortness of breath Productive cough “smoker's cough” Decreased tolerance, hypoxic with exercise Frequent pulmonary infections Decreased FEV1, FEC FRC & RV increased Increased Paco2, Hypoxemia, Polycythemia Cyanosis “Blue Bloater”
Risk Factors: COPD (Emphysema & Chronic Bronchitis)
Smoking predominant Cause Alpha-1antitrypsin deficiency Occupational exposure, pollution Diet deficient in vitamin C Low Birth weight Childhood respiratory infections Pre-existing bronchial hyper-responsiveness Low social class
Global Initiative: COPD
Potential Complications: COPD
Hypoxemia (paO2 of 55mmHg or less with an oxygen saturation of 85% or less)
Cor Pulmonale (Right Sided Heart Failure) Respiratory Acidosis & Hypercapnia (increased
paCO2):
Oxyhemoglobin Dissociation Curve
The oxyhemoglobin dissociation curve is an important tool for understanding how our blood carries and releases oxygen. Specifically, the oxyhemoglobin dissociation curve relates oxygen saturation (SO2) and partial pressure of oxygen in the blood (PO2), and is determined by what is called "hemoglobin's affinity for oxygen," that is, how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue.
Potential Complications: COPD
Hypoxemia (paO2 of 55mmHg or less with an oxygen saturation of 85% or less)
– Mood changes
– Forgetfulness
– Inability to concentrate
– Cyanosis a late sign of hypoxia
Potential Complications of COPD Respiratory Acidosis & Hypercapnia (inc.
pCO2):
– Decrease in oxygen/carbon dioxide exchange
– Rising carbon dioxide levels result in respiratory acidosis (CO2 makes ACID)
– SOB (increased Respiratory rate)
– Headache
– Confusion
– Lethargy
– Nausea and Vomiting
Potential Complications COPD
Cor Pulmonale (Right Sided Heart Failure)
– Progressive shortness of breath with activity
– Chest pain under sternum
– Weakness
– Neck vein distention, edema
– Enlarged liver
– Right ventricular hypertrophy
Obstructive Lung Disease: Asthma“Chronic inflammatory disorder of the airways
involving hyper-responsiveness and airway obstruction”
Periods of attacks of wheezing shortness of breath
Tight feeling in the chest
Cough that produces mucous
Due to an allergic reaction
Triggered by certain drugs, irritants, viral infection, exercise emotional stress
Pathophysiology: Asthma
Familial Allergen Exposure initiates immune response IL-4 activates IgE production, mast cell
degranulation Releases histamine, prostaglandins, leukotrienes Bronchospasm, congestions, mucous production Bronchial Hyper-responsiveness
Asthma: Signs & Symptoms
Asymptomatic between attacks Chest constriction Expiratory Wheezing Dyspnea Non productive cough Tachycardia, tachypnea Pulsus Paradoxus
Asthma: Signs & Symptoms (Cont.)
Hypoxemia with low pCO2 Respiratory fatigue/failure: pco2 may rise Eosinophilia (allergy) Decreased FEV1 Decreased peak expiratory flow rate
Risk Factors: Asthma
Asthma: EvaluationTreatment
Treat precipitating event Oxygen therapy Hydration Antibotics (with infection) Meds: bronchodilators, steroids, mast cell
stabilizers, methylxanthines
Nursing Diagnosis: COPD
Ineffective airway clearance r/t Airway spasm Retained secretions Excessive mucous Fatigue
Impaired gas exchange r/t Descreased lung expansion Decreased LOC Presence of pulmonary secretions
Nursing Diagnosis: COPD
Ineffective breathing patterns r/t Hyperventilation Hypoventilation Anxiety fatigue
Planning (Goals)
Breath sounds clear A&P Respirations between 12-20/min SaO2 90% or greater Ambulate ___ feet QID
Implementation: Promoting Lung expansion
Positioning Breathing exercises Chest Physiotherapy Oxygen Therapy
Implementation: Promoting Lung expansion
Positioning: change at least Q2 hrs
Implementation: Promoting Lung expansion
Breathing exercises: to expel secretions from lungs
CDB Q2 hrs Pursed lip breathing
Helps COPD patients to evacuate more air by breathing out against pressure
Abdominal Breathing (diaphragmatic) Promotes alveoli expansion and emptying
Implementation: Mobilizing Pulmonary Secretions
Hydration Keeps pulmonary secretions moist, easy
to expectorate Fluid intake 1500-2000 cc/day
Humidification Air or oxygen with increased humidity
will help to keep airways moist to loosen and mobilize pulmonary secretions
Nebulization Adding fine drops of moisture to the
respiratory tract
Implementation: Mobilizing Pulmonary Secretions
Chest physiotherapy Chest percussion (cupping)
Vibration: fine shaking pressure applied to chest wall only during exhalation (helps get rid of trapped air) vest
Implementation: Mobilizing Pulmonary Secretions
Chest physiotherapy Postural Drainage:
positioning
(not good for emphysema/bronchitis don’t tolerate asthma not needed. Just for CF-bronchitis w/o emphesema
Case Study
Journal Article: COPDthe role of the nurse by Barnett
Nurses have a key role
in the prevention and
treatment of COPD in
advising and
supporting patients
living with this
condition.
Nurses Role
Prevention & Treatment Recognize clinical symptoms Recognize Associated Risk Factors Medications Available
Effectiveness(Questions)
Patient Education: Smoking Nutrition Activity Vaccination
Discussion
Patient Factors for COPD/Single Most Factor
Clinical Manifestations of Bronchitis/Emphysema
COPD Staging
Arterial Blood Gas indicative of which Serious Condition
Pulmonary HTN/Cor Pulmonale Clinical Manifestations
Restrictive vs Obstructive Disease
http://www.youtube.com/watch?v=wbcjFpyxkpc&feature=related http://www.youtube.com/watch?v=wbcjFpyxkpc&feature=related
References
Barnett, Margaret. (2006, February). COPD: the role of the nurse. Journal of Community Nursing, 20(2), 18-20,22. Retrieved October 26, 2010, from Research Library. (Document ID: 989426231).
Bauldoff, G. (2009). When breathing is a burden: how to help patients with COPD. American Nurse Today, 4(9), 17-22. Retrieved from CINAHL
database.
National Heart Lung and Blood Institute http://www.nhlbi.nih.gov/health/public/lung/copd/.
American Lung Association http://www.lungusa.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html