COPD DISEASE DEFINITION TYPES Chronic Obstructive Pulmonary Disease (COPD)

It is a respiratory disorder that is mainly caused from smoking. It Is characterized by progressive, partially reversible airflow obstruction, increasing frequency and severity of exacerbations, and systematic manifestations. Two types of obstructive airway disease encompass COPD; chronic bronchitis and emphysema. Chronic Bronchitis is defined as hypersecretion of mucus and chronic productive cough for at least 3 months of the year (usually in the winter) for at least 2 consecutive years. Emphysema is a chronic airflow obstruction disease characterized by permanent enlargement of air spaces distal to the terminal bronchioles with destruction of alveolar walls (without fibrosis) and accompanied by exertional dyspnea. Cigarette Smoking: Exposure to tobacco smoke id the main cause of 80-90% of the COPD cases in Canada. Occupational Chemicals and Dusts: COPD can develop independently of cigarette smoking, if a person has intense or prolonged exposure to various dusts, vapours, irritants or fumes in the workplace. Infection: Recurring respiratory tract infections are a major contributing factor to the aggravation and progression of COPD. Heredity: 1-Antitrypsin (AAT) deficiently is the only know genetic abnormality that leads to COPD. Aging: Some degree of emphysema is common in the lungs of the older person, even a non-smoker. The results of aging are changes in the lung structure, the thoracic cage, and respiratory muscles that cause a gradual loss of the elastic recoil of the lung. The lungs become smaller and stiffer. The number of functional alveoli decreases as a result of the loss of the number alveolar supporting structures. Thoracic cage changes result from osteoporosis and calcification of the costal cartilage. The thoracic cage becomes stiff and rigid, and the ribs are less mobile. These changes result in a decreased compliance of the chest wall and an increase in the work of breathing COPD-Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Mechanisms of air trapping in COPD: Mucous plugs and narrowed airways cause air trapping and hyperinflation of alveoli on expiration. Chronic Bronchitis-Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. Bronchial edema and increase in the size and number of mucous glands and goblet cells in the airway epithelium are caused from continual bronchial inflammation. Thick, tenacious mucus is produced and cannot be cleared because of impaired ciliary function. The lung s defense mechanisms are, therefore, compromised, increasing susceptibility to pulmonary infection and injury. Emphysema: Recurrent inflammation associated with the release of proteolytic enzymes from lung cells which cause abnormal, irreversible enlargement of the air spaces distal to the terminal bronchioles. The amount of alveolar surface area available for gas exchange decreases. This enlargement leads to the destruction of alveolar walls in the distal or terminal airways, which results in a breakdown of elasticity. Elastic recoil is reduced, limiting airflow. Supporting alveolar structures are lost, leading to narrowing of the airway, which further limits airflow. The airways and lung parenchyma are involved. These changes result in impaired carbon dioxide and oxygen exchange. y Dyspnea, difficulty breathing, shortness of breath y Intermittent cough/progressive cough y Sputum production

EPIDEMIOLOGY / RISK FACTORS

ALTERATION

CLINICAL MANIFESTATIONS

Asthma
Physical Findings y Barrel chest y Pursed-lip breathing y Use of accessory muscles y Cyanosis y Clubbed fingers and toes y Tachypnea y Decreased tactile fremitus y Decreased chest expansion y Hyperresonance y Decreased breath sounds y Crackles y Inspiratory wheeze y Prolonged expiratory phase with grunting respirations y Distant heart sounds y Cor Pulmonale, right heart failure y Acute exacerbations of COPD y Acute respiratory failure y Skeletal muscle dysfunction y Secondary polycythemia y Depression, anxiety and panic y Altered nutrition y Respiratory assessment & status, including ease of breathing, evidence of retractions, and changes in breath sounds y Vital signs y Intake and output y Daily weight y Signs and symptoms of complications y Effectiveness of medications y Activity tolerance y y y y y y y y y y y y y y y y y y y Smoking cessation, if smoker Bronchodilator therapy 2-adrenergic agonists Anticholinergic agents Corticosteroids (oral for exacerbations) Antibiotics for exacerbations with purulent sputum Long term oxygen, if indicated Prompt treatment of respiratory infections Yearly influenza immunization Pneumovax immunization Pulmonary rehabilitation program Breathing exercises Chest clearance technique Hydration of 3 L/day(if not contraindicated) Nutritional supplement if low BMI Client and family teaching Surgery in severe and advanced COPD Activity intolerance Anxiety

COMPLICATIONS

ASSESSMENTS

TREATMENTS

NURSING DIAGNOSES

Asthma

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Fatigue Fear Impaired gas exchange Ineffective airway clearance Ineffective breathing pattern Interrupted family processes Risk for infection

INTERVENTIONS

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Give prescribed drugs via appropriate route; if I.V. route is necessary, ensure patent I.V. access. Administer oxygen as ordered based on pulse oximetry readings and ABG results. Auscultate lungs for evidence of adventitious breath sounds. Elevate the head of the bed to ease the work of breathing. Provide supportive care; offer guidance and suggestions as indicated. Help the patient adjust to lifestyle changes necessitated by a chronic illness. Encourage the patient to express his fears and concerns. Perform chest physiotherapy; encourage coughing and deep-breathing using pursed-lip breathing technique. Provide a high-calorie, protein-rich diet. Give small, frequent meals to minimize energy expenditure associated with eating. Encourage daily activity and diversional activities. Provide frequent rest periods.