COPD

Created @October 3, 2021 6:10 PM

Tags RLE

Chronic Obstructive Pulmonary Disease (COPD)

: A chronic airway obstruction that results from emphysema and chronic bronchitis or any combination of these disorders.

Cause
: Predisposing factors - cigarette smoking, recurrent or chronic
respiratory infections, and allergies
: Smoking is by far the most important of these factors.
: Hereditary factors - Deficiency of alpha1-antitrypsin
Pathophysiology
: Impairs cilliary action and macrophage function causing inflammation
in the airways, increased mucus production, destruction of alveolar
septae, and peribronchiolar fibrosis.
: Early inflammatory responses are reversible if the patient stops
smoking.

Grades of COPD
Grade Severity Pulmonary Function

Grade I Mild FEV1/FVC <70%; FEV1 ≥ 80% predicted

Grade II Moderate FEV1/FVC <70%; FEV1 50-80% predicted

Grade III Severe FEV1/FVC <70%; FEV1 <30-50% predicted

Grade IV Very Severe FEV1/FVC <70%; FEV1 <30% predicted

General Treatment and Nursing Interventions

Urge the patient to stop smoking and avoid other respiratory
irritants
Set a good example by not smoking
Explain that bronchodilators alleviate bronchospasm and enhance
mucociliary clearance of secretions.
Administer antibiotics, as ordered, to prevent respiratory infections.
Stress the need to complete the prescibed course of the antibiotic
therapy.
Teach the patient and family how to recognize early signs of
infections
Warn the patient to avoid contact with persons with respiratory
infections.
Encouurage good oral hygiene to help prevent infections
Teach the client to cough effectively to mobilize secretions.
If the patient with copious secretions has difficulty mobilizing
secretions, teach the patrient postural drainage and chest
physiotherapy
If secretions are too thick, urge the patient to drink at least 12-
15 glasses of fluid a day
A home humidifier may be beneficial
Emphazise the importance of balanced diet.
Since the patient may tire easily when eating, suggest
frequent small meals and consider using oxygen administered
by nasal cannula during meals.
Help the patient and family adjust their lifestyles to accommodate
the limitations imposed by this debilitating disease chronic disease

Pneumoccocal vaccination every 5 years and annual influenza Instruct the patient to allow daily rest periods and to exercise
vaccinations daily as the physician directs.

Teach the patient to take slow, deep breaths and exhale through As COPD progress, encourage the patient to discuss his fears
pursed lips to strengthen the muscles of respiration ( Emphysema )
Advise all people, especially those with family history of COPD or
Administer low concentrations of oxygen, as ordered. those in its early stages not to smoke, to help prevent COPD

Perform blood gas analysis to determine O2 need and to avoid Assist in the early detection of COPD by urging perosns to have
CO2 narcosis. periodic physical examinations, including spirometry and medical
evaluation of a chronic cough
If patient is to continue O2 therapy at home, teach the patient
how to use the equipment correctly Seek medical treatment for recurrent respiratory infections
promptly.
Teach patient and family that excessive O2 therapy may
eliminate the hypoxic respriatory drive, causing confusion and
drowsiness, signs of CO2 narcosis

Keep the oxygen at 85-92% via nasal cannula or venturi mask

COPD 1
 📢 The nurse should caution the patient that smoking with or near oxygen is extremely dangerous.

Emphysema ( Pink Puffers )

: Abnormal irreversible enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar walls resulting in decreased elastic
recoil properties of lungs.

Causes and Pathophysiology

: Cigarette smoking, deficiency of alpha-antitrypsin
: Recurrent inflammation associated with release of proteolytic enzymes from cells in the lungs causes bronchiolar and alveolar wall damage and,
ultimately destruction.
: Loss of lung supporting structure decreases in elastic recoil and airway collapse on expiration → destrcution of alveolar walls decreases surface area
for gas exchange.

Arterial Blood Gas

Diagnostics Measures Clinical Features Management
Reduced PO2 with
Physical examination Insidious onset, with dyspnea Bronchodilators - to
normal PCO2 until
the predominant symptom reverse bronchospasms
Hyperresonance in late in disease
and promote mucocilary
percussion Hallmark sign: Structural
EKG clearance
changes
Decreased breath sounds
Tall, symmetric P Aminophylline
Other signs and symptoms
Expiratory prolongation waves in leads II, III,
Antibiotics - to treat
and AVF Chronic cough
Quiet heart sounds respiratory infection
Vertical QRS axis Anorexia
Chest X-ray (in late disease) Vaccines
Signs of right Weight loss
Flatten diaphragm Flu vaccine - to
ventricular Malaise
Reduced vascular prevent influenza
hypertrophy (in late
markings at lung disease) Barrel chest Pneumovax - to
periphery prevent pneumococcal
Use of accessory muscles
CBC
Over-aeration of lungs pneumonia
Prolonged expiratory
Increased hemoglobin
Vertical heart period with grunting Adequate fluid intake
(late in disease when
(depends on the patient)
Enlarged anteroposterior persistent severe Pursed-lipped breathing
chest diameter hypoxia is present) and tachypnea Chest physiotherapy - to
mobilize secretions
Large retrosternal air Peripheral cyanosis
space O2 in low-flow settings to
Digital clubbing
treat hypoxia
Pulmonary function tests
(Gold standard) Avoidance of smoking and
air pollutants
Increased residual
volume, total lung
capacity, and compliance

Decreased vital capacity,

diffusing capacity

Large retrosternal space

Chronic Bronchitis ( Blue Bloaters )

: Excessive mucus production with productive cough for at least 3 months a year for 2 successive years.

Cause and Pathophysiology

: Hypertrophy and hyperplasia of broncial mucous glands → increased goblet cells, damage to cilia, squamous metaplasia of columnar epithelium →
chronic leukocytic and lympthocytic infiltration of bronchial walls.
: Wide spread inflammation, distortion, narrowing of airways, and mucus within the airways produce resistance in small airways and cause severe
ventilation-perfusion (V/Q) imbalance.

Diagnostic Measures Clinical Features Management

Physical Examination Insidious onset, with productive cough Antibiotics for infections
and exertional dyspnea the predominant
Rhonchi and wheezing on Avoidance of smoking and air pollutants
symptoms
auscultation
Bronchodilators to relieve bronchospasm
Hallmark sign: Chronic productive
Expiratory elongation and facilitate mucociliary clearance
cough
Neck vein distention

COPD 2
 Pedal edema
Chest X-ray
May show hyperinflation and
increased bronchovascular markings
Pulmonary function tests (Gold
standard)
Increased residual volume
Decreased vital capacity and forced
expiratory volumes
Other signs and symptoms Adequate fluid intake and chest
physiotherapy to mobilize secretions
Colds associated with increased
sputum production Ultrasonic or mechanical nebulizer
treatment to loosen secretions and aid in
Worsening dyspnea which take
mobilization
progressively longer to resolve
Occasionally, patients respond to
Copious sputum (gray, white,
corticosteroids
yellow)
Diuretics for edema
Weight gain due to edema
Oxygen for hypoxia
Cyanosis

Normal static compliance and Tachypnea

diffusion capacity
Wheezing on expiration
Arterial Blood Gas
Prolonged expiratory time
Decreased PO2
Use of accessory muscles of
Normal or increased PCO2 respiration

Sputum

Contains many organisms and

neutrophils

EKG

May show arterial arrythmias

Peaked P waves in lead II, III, AVF

Occasionally, right ventricular

hyperthrophy

COPD 3