final copd mam somo
TRANSCRIPT
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Overview Currently, COPD is the fourth leading cause of
mortality and the 12th leading cause of disability.
However, by the year 2020 it is estimatedthat COPD will be the third leading cause ofdeath and the forth leading cause of disability(Sin, McAlister, Man. Et al., 2003).
People with COPD commonly becomesymptomatic during the middle adult years, andthe incidence of the disease increases with age.
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Predisposing Factor
-increases mucusproduction in thelungs andparalyzes the cilia
-too much mucusclogs the gasexchangefunction of your
air sacs -Smoking can
interfer in yourability to cough
effectively
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PATHOPYSIOLOGY In COPD, the airflow limitation is both
progressive and associated with an abnormal
inflammatory response of the lungs to noxiousparticles or gases. The inflammatory responseoccurs throughout the airways, parenchyma, andpulmonary vasculature. Because of the chronic
inflammation and the bodys attempts to repair it,narrowing occurs in the small peripheral airways.
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. Over time, this injury-and-repair process causesscar tissue formation and narrowing of the airway
lumen. Airflow obstruction may also be caused byparenchymal destruction, as is seen withemphysema, a disease of the alveoli or gasexchange units.
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What COPD is: The deadly combo In the vast majority of patients, COPD refers to a
combination of a chronic bronchitis and
emphysema. Most COPD patients have bothconditions, although one maybe more advancethan the other.
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CHRONIC BRONCHITIS a chronic inflammation of the bronchi
(medium-size airways) in the lungs. It is
generally considered one of the two formsof (COPD).It is defined clinically as apersistent cough that produces sputum(phlegm) and mucus, for at least threemonths in two consecutive years.
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-an increasednumber andincreased size of the
goblet cells andmucous glands of theairway.
-BLUE BLOATERS
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Narrow opening
Excess mucus
Inflamed airwaywith significantswelling.
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Sympotms include chronic coughing and throatclearing, increased mucus and shortness of
breath.
To meet the clinical definition of chronicbronchitis you must cough up mucus most days
for atleast 3months for two consecutive years.
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Pathophysiology
smoking/pollution
continued irritation of lungpassages
inflammation
excessive mucusproduction
narrowing of the
bronchi
Chronic
Bronchitis
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EMPHYSEMA
characterized by loss of elasticity(increased pulmonary compliance) of thelung tissue caused by destruction ofstructures feeding the alveoli.
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EMPHYSEMA -takes time to
develop, 9 out of 10people diagnosed
with it are 45 yearsold and up
- characterized byloss of elasticity
(increasedpulmonarycompliance) of thelung tissue caused bydestruction ofstructures feeding
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This causes thesmall airways to
collapse duringforced exhalation,as alveolarcollapsibility has
decreased.
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Pathophysiology
Smoking/Pollutants
Attraction of inflammation cells
Release of
elastaseinhibition of alpha 1-antitrypsin
inherited alpha 1-antitrypsindeficiency
destruction of
elastic fibers
Emphysema
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Emphysema Chronic BronchitisAge 40-50 30-40
Clinical Findings
Barrel Chest Often dramatic infrequent
Wt. loss Maybe absent in early
disease
Maybe present
Shortness of
Breathing
Maybe frequent Maybe present,
predominant early
symptomsBreath Sound
Wheezing Absent Variable
Rhonchi Absent Often prominent
Sputum Often absent, maybepresent in late course Frequent earlymanifestation
Blood Gasses Relatively normal until
late process
Hypercapnia and
Hypoxemia is present
Cor Pulmonale Only in advance cases Frequent
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ASSESSMENTHISTORY
Health perception-health management Greater than normal shortness of breath, with
inability to control symptoms with prescribed ornon prescribed therapies.
Increased fatigue and inability to cope with crisis
Increasing anxiety and panic
Increasing difficulty expectorating sputum
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Nutritional-metabolic pattern
Anorexia Inability to eat and digest without shortness ofbreath
Nausea, possibly associated with medications Bloating, especially after eating foods known
cause flatulence
Difficulty maintaining adequate fluid intake (atleast 8 oz/240ml glasses per day).
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Activity-exercise pattern Shortness of breath with even minimal exertion
or when performing activities of daily living
Shortness of breath and panic controlled withbreathing techniques
Sleep-rest pattern
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PSYCHOSOCIAL
Cognitive-perceptual pattern Fluctuating compliance with therapeutic regimen
Role-relationship pattern
Multiple role changes, resulting in depression,isolation and increased dependence
Difficulty verbalizing feelings because emotionsintensify shortness of breath
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Sexuality-reproductive pattern
Complex interpersonal role changes with spouseor partner, with decreased desire for andfrequency of sexual activity because of actual orpotential shortness of breath.
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Coping-stress tolerance pattern
Difficulty expressing either positive or negativeemotions because of shortness of breath
Fluctuating behaviour
Value-belief pattern
Ambivalence about resuscitative measures thatmay be necessary during hospital stay but maynot ultimately improve quality of life
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PHYSICAL
General Appearance Apprehension and anxiety; maintenance of
upright tense posture
Tendency to panic easily if activity is requested
Cachexia (emphysema); plethora (chronicbronchitis)
Cardiovascular
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Pulmonary
Accentuated accessory neck muscles Barrel chest hyperinflation
Decreased breath sounds bilaterally
Prolonged expiratory phase Productive cough: tapioca-like plugs or copious
amounts of sputum
Gurgles if secretions are copious; crackles if heart
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Neurologic
Anxiety Restlessness with hypoxemia
Lethargy and sleepiness with increased partialpressure of carbon dioxide levels
Integumentary
Skin that discolours (mottling and cyanosis)easily during coughing spells, strenuous activity,or episodes of acute shortness of breath
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DIAGNOSIS Spirometry- used to evaluate airflow obstruction,which is determined by the ration FEV1 to force
vital capacity (FVC) Broncodilator Testing- peformed to rule out the
diagnosis of asthma.
Arterial blood gas (ABG) measurements- assessbaseline oxygentation and gas exchange and isimportant in advance COPD.
Theopylline level- normal is 10 to 15ug/ml; maybe elevated if the atient has ad usted
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Alpha1-antitrypsin assay- uncommon; performedto determine alpha1 antitrypsin deficiency in
young patients with suspected emphysema Other tests- white blood cell count,
hematocritand serum electrolytes levels are
performed according to suspected causes. Chest X-ray- shows hyperinflation, with flattening
of the diaphragm caused by air trapping in thechest, that may worsen during exacerbation; may
also show infiltrates, depending on exacerbation
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TREATMENT
The goals of COPD treatment are: 1) to prevent further deterioration in lung
function, 2) to alleviate symptoms,
3) to improve performance of daily activities andquality of life.
The treatment strategies include
1) quitting cigarette smoking,
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PROBLEM LIST Impaired Gas Exchange related to airway
narrowing secondary to mucus secretions and
inflammation Ineffective airway clearance related to excessive
secretions
Nutritional deficit related to shortness of breathduring and after meals and adverse reactions tomedication.
Ineffective cardiopulmonary tissue perfusionrelated to im aired ventilation secondar to
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UPDATES Patients With COPD Have Higher Risk of
Shingles, Study Finds
ScienceDaily (Feb. 23, 2011) Patients withchronic obstructive pulmonary disease (COPD)are at greater risk of shingles compared with the
general population, according to a studypublished in CMAJ(Canadian MedicalAssociation Journal). The risk is greatest forpatients taking oral steroids to treat COPD.
Shingles, or herpes zoster, is a reactivation of the
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People with a compromised immune system areat greater risk of developing shingles although it
has not been previously studied in patients withCOPD.
There is increasing evidence that COPD is an
autoimmune disease. "Given that variousimmune-mediated diseases, such as rheumatoidarthritis and inflammatory bowel disease, havebeen reported to be associated with an increased
risk of herpes zoster, it is reasonable toh othesize that immune d sre ulation found in
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This study, using data from the TaiwanLongitudinal Health Insurance Database,
included 8486 patients with COPD and 33 944subjects from the comparison cohort. Of the totalsample of 42 430 patients, 1080 had incident ofherpes zoster during the follow-up period. There
were 321 cases of shingles identified in the COPDcohort, 16.4 per 1000 person years, and 759 casesin the comparison cohort, 8.8 per 1000 personyears.
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"Our cohort study demonstrated that patientswith COPD are at an increased risk of developing
herpes zoster compared with the generalpopulation, after controlling for other herpeszoster risk factors," write the authors. "The risk ofherpes zoster associated with COPD is greater for
patients with inhaled or oral corticosteroidstherapy than patients without."
The authors conclude it is possible that "increased
disease severity further contributes to theincreased risk of her es zoster associated with
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