CHRONIC

OBSTRUCTIVE
PULMONARY
DISEASE(COPD)
PRESENTED BY
ATHIRA.U
PBDSN, CRITICAL CARE
COLLEAGE OF NURSING ,TVPM
 DEFINITION

Chronic obstructive pulmonary

disease is a disease state characterized
by the presence of airflow obstruction
caused by chronic bronchitis or
emphysema.
. CHRONIC BRONCHITIS
Chronic inflammation of the lower respiratory
tract characterized by excessive mucous secretions,
cough and dyspnoea associated with recurrent
infections of the lower respiratory tract.

.EMPHYSEMA
It is the abnormal permanent enlargement of
airspaces distal to the terminal bronchioles
,accompanied by destruction of there walls and
without obvious fibrosis
Conti…..
INCIDENCE
 COPD is currently the fourth leading cause of death in
the world.

 COPD is projected to be the third leading cause of

death by 2020.

 More than 3 million people died of COPD in 2012

accounting for 6% of all death globally.

 Globally ,the COPD burden is projected to increase in

coming decades because of continued exposure to
COPD risk factor and aging of the population.
ETIOLOGY
.Cigarette smoking
Hyperplasia of the cell which result
increased production of mucous
. Infection
Recurrent respiratory tract infections.
. Hereditary
Alpha- antitrypsin (AAT) deficiency.
. Aging
Older person
. Second hand smoker
. Pollution and fumes
. Genes
RISK FACTORS
 Exposure to tobacco smoke.

 People with asthma.

 Occupational exposure of dust and chemicals

 Exposure of fumes and burning fuels

 History of childhood respiratory infection.

PATHOPHYSIOLOGY
Tobacco
smoke,airp
ollution

Breakdown of
Continual elatsin in
bronchial connective
irritation ,and tissue of
inflammation lungs

Chronic EMPHYSEMA
bronchitis
Conti…

Airway obstruction, air trapping , dyspnea,

frequent infections

Abnormal ventilation perfusion ratio,

hypoxemia ,hypoventilation , cor
pulmonale
CLINICAL MANIFESTATION
 Cough
 Sputum production
 Dyspnoea on exertion, it may be severe and interfere

with patient activities.

 Weight loss
 Wheezing
 Chest tightness
 Cyanosis
 Fatigue and anxiety
 Haemoptysis
 Anaemia
COMPLICATION

.Core pulmonale
it is the hypertrophy of the right side of the
heart ,with or without heart failure ,resulting from
pulmonary hypertension.
Clinical features
*Heart sound changes
*ECG changes: increased amplitude of p wave
*Right sided ventricular diastolic S3 gallop
*Distended neck vein
*peripheral oedema
Conti…..
.Acute exacerbations of chronic bronchitis
Airways are colonized with
streptococcus pneumonia and homophiles
influenza which cause inflammatory response
and impair the function of mucocillary system
.Acute respiratory failure
Acute respiratory tract infections or
acute bronchitis.
Contin….
.Peptic ulcer and gasro oesophagal reflux disease
the side effect from the long term use of
bronchodilators and corticosteroids,
.Pneumothroax
.pulmonary hypertension
.pneumonia
Due to infection airways becomes blocked
With mucous .which can make difficulty in breathing
Conti….
.PULMONARY HYPERTENSION
.Depression and anxiety disorders
.heart problem
.death
DIAGNOSTIC
.History and physical examination
.ABG
.ECG
For detecting right ventricular failure
.O2 saturation monitoring with pulse oximetry
.Pulmonary function test
Spirometry
.chest Xray
Conti…..
.Alpha antitrypsin deficiency screening
under the age of 45 and those with family
history of COPD
.Laboratory examination
sputum examination(streptococcus
pneumonia)
TREATMENT
.Smoking cessation
.Bronchodilators
make breathing easier by relaxing and widening
the lung
*Short acting bronchodilators
eg. :albuterol ,metaproternol ,levabuternol
*Long acting bronchodilators
eg :. Beta agonist inhalers
salmetrol , frmetrol
.anti mucuscarinic inhalers
titropium , glycopyrinoium
Conti….

.Steroid inhalers
eg:prednisone, hydrocrtisone
.Mucolytics
eg:Acetylcysteine
.Antibiotics
eg:cefuroxime,cefopdoxime,amoxicillin(750mg)
amoxycillin with clavulate((500mg/125mg)
.Oxygen therapy
.Collaborative care
.Neutritional therapy
.pulmonary rehabiilitation
SURGICAL MANAGEMENT
 Bullectomy
 Lung volume reduction surgery
 Lung transplantation
NURSING DIAGNOSIS
 Ineffective airway clearance related to
expiratory airflow obstruction, ineffective
cough, decreased airway humidity manifested
by infective or absent cough, presence of
abnormal breath sounds
 Impaired gas exchange related to alevolar

hypoventilation as manifested by headache

on awakening
 Anxiety related to aute breathing difficulties

and fear of suffocation

Conti…
 Activity intolerance related to inadequate
oxygenation and dyspnea
 Imbalanced nutrition less than body

requirements related to poor appetite

lowered energy level ,shortness of breath
 Disturbed sleeping pattern related to anxiety

,dyspnea depression and shortness of breath

 THANK YOU