Copd | Respiratory Tract | Lung

CHRONIC OBSTRUCTIVE PULMONARY DISEASE Author: Emanel, Roen Mar Lope, Christine Joy

INTRODUCTION: COPD or Chronic Obstructive Pulmonary disease - chronic lung conditions that obstruct the airways in your lungs - refers to obstruction caused by CHRONIC BRONCHITIS and EMPHYSEMA - theres a blockage within the tubes and air sacs that make up the lungs which hinders the ability to exhale and even breath TYPES Related Anatomy: In humans it is the two main bronchi that enter the roots of the lungs. The bronchi continue to divide within the lung, and after multiple divisions give rise to bronchioles . The bronchial tree continues branching until it reaches the level of terminal bronchioles , which lead to alveolar sacks. Alveolar sacs are made up of clusters of alveoli, like individual grapes within a unch. The individual alveoli are tightly wrapped in blood vessels, and it is here that gas exchange actually occurs. Deoxygenated blood lungs , where oxygen in the hempglobin of the erythrocytes. The oxygen-rich blood returns to the heart via pulmonary veins to be pumped back into systemic circulation.

Human lungs are located in two cavities on either side of the heart. Though similar in appearance, the tow are not identical. Both are separated into lobes on the right and two on the left. The lobes are further divided into lobules hexagonal divisons of the lungs that are the smallest subdivision visible to the naked eye. The connective tissue that divides tobules is often blackened in smokers and city dwellers. The medial border of the right lung is nearly vertical , while theleft lung contains a cardiac notch. The cardia notch is a concave impression molded to accommodate the shape of the heart. Lungs are to a certain

extent overbuilt and have a tremendous reserve volume as compared to the oxygen exchange requirements when at rest. This is the reason that individuals can smoke for years without having a noticeable decreased in lung function while still or moving slowly ; in situations like these onlya small portion of the lungs are actually perfursed with blood for gas exchange. As oxygen requirements increased incrased due to exercise , a greater volume if the lung is perfused allowing the body to match its CO2/o2 exchange requirements The environment of the lung is very moist which makes it hospitable for bacteria. Many respiratory illnesses are the result of bacterial or viral infection of the lungs. PATHOPHYSIOLOGY Chronic bronchitis is defined in clinical terms as a cough wih sputum production on most days for 3 months of a year, for 2 consecutive years. Chronic Bronchitis is hallmarked by hyperplasia (increased in number) and hypertrophy (increased in size) of goblet cells (mucous gland) of the airway, resulting in an increase in secretion of mucous which contributes to the airway obstruction. Microscopically there is infiltration of the airway walls with inflammatory cells, particularly neutrophils . Inflamation is followed by scarring and remodeling that thickens the walls resulting in narrowing of the small airway. Further progression leads to metaplasia abnormal change in the tissue) and fibrosis (further thickening and scarring) of the lower airway. The consequences of these changes is a limitation of airflow. Emphysema Emphysema is defined histologically as the enlargement of the air spaces distal to the terminal bronchioles , with distructionof their walls. The enlarged air sacs (alveoli) of the lungs reduces the surface area available for the movement of the gases during respiration. This ultimately leads to dyspnea in severe cases. The exact mechanism for the development of emphysema is not understood although it is known to be linked with smoking and age.

TYPES OF EMPHYSEMA Paniobular (or panacinar) Emphysema This y\type of emphysema is characteristic of a weakening and inflammation of alveoli at the end of the bronchioles. When destruction is very severe the affected acinus disappears and the lungs appear “spider web-like” in xrays. A mild version of this type of emphysema occurs as aging progresses. In younger people, this panlobular emphysemais caused by the bodysinability to produce sufficient amounts of alpha-1 antitypsin Centrilobular (or centriacinar) Emphysema This type of emphysema affects single alveoli entering directly into the walls of terminal and respiratory bronchioles. Asthma: Underlying problem is the inflammation as a result of complex interactions among the inflammatory cells, mediators and the tissues in the airwas. Stimuli activate the release of inflammatory mediators from the mast cells, macrophages, eosinophils and other cells in the airways. The mediators signal other inflammatory cells to migrate to the airways where they are activated. This causes injury of the epithelium. Prolonged contraction of smooth muscle an secretion of mucus, as well as swelling in the involuntary contriol of the airway. Inflamed airways become more narrow and obstructed. Inflammation also causes hyper-responsiveness of the airway, which also results in excessive narrowing of the airways when a stimulus is introduced . Stimuli can include viral respiratory infections, such as colds, which trigger most attacks, other stimuli are allergens such as pollen or mold; irritants such as tobacco smoke , cold air or exercise “ Trigger” is another term for a stimulus that triggers. Airways obstruction can develop suddenly or gradually and causes the symptoms associated with astma , wheezing, coughing, shortness of breath, chest tightness and decreased endurance.

RISK FACTORS: Smoking Exposure to occupational and environmental pollutants Genetic factors Allergies and Asthma Nutrition Periodontal Disease Low Birth Weight Age, Gender, Ethnic Background Signs and Symptoms: Cough Dyspnea Wheezing Chestpain Hemoptysis Cyanosis Swelling Respiratory failure DIAGNOSTIC TEST Spirometer Forced Vitl Capacity (FVC) Residue Volume (RV) Diffusing Capacity Lung Test Chest X-ray CT Scan (computerized Tomography) Mucous Culture TREATMENT; Bronchodilators Inhaled Glucocorticosteroids (steroids) Flu Shots Pneumococcal Vaccine Pulmonaryt Rehabilitation SURGICAL: Bullectomy Lung volume Reduction Surgery (LVRS) Lung Transplant NURSING CARE: Eliminate or minimize exposure to all pulmonary irritant Clear airways with postural drainage, clapping or vibrating and suctioning as appropriate Administer oxygen at the prescribed percentage Encourage rest Assess for drug allergies especially to antibiotics before administering Also prescribed , administer bronchodilators mucolytic agents and corticosteroid Provide client and family teaching , covering disease process and treatments, breathing restraining exercises, energy conservation, use of inhalers and nebulizers medication administration and the importance of compl;iance , prevention of complications and infections by receiving influenza and medications prescribed

SPECIAL INSTRUCTIONS: Demonstrate the use of bronchodilator nebulizers Teach and demonstrate to the patients and caregiver and adaptive breathing techniques : deep breathing exercise, coughing and techniques , pursed lip breathing, abdominal breathing and position for postural drainage Explain the need to avoid persons with infection like flu Explain the importance of taking vaccines for influenza Instruct the patient and caregiver on cleaning of home respiratory equipments Explain the need to avoid persons with infection like flu Explain the importance of taking vaccines for influenza Instruct the patient and caregiver on cleaningof akk home respiratory equipments Esplain the need to avoid going out in cold temperatures which may cause bronchospasms



Stress the importance of not smoking and avoiding second hand smoke Suggest avoiding clothing that restricts chest or abdominal expansion

For Activity: Diet: Explain the need to maintain high-calorie diet as indicated Encourage fluid intake at 2000-3000 mL/day to keep secretions clean Suggest small, frequent meals to avoid abdominal distention Avoid gas-producing foods Advise the patient to exercise to tolerance and to avoid fatigue by planning rest periods during the day Instruct the patient to breath deeply and slowly during the periods of a activity Discuss energy convertion techniques Instruct patients to avoid emotiona stress

Home Care Referral: Give both the patient and the caregiver verbal and written instructions Review the signs and symptoms to be reported by the patient to the physician or nurse; elevated temperature , sore throat, increased sputum form clear white to yellow green , increases diffuculty in breathing decreased activity intolerance, decreased appetite).

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