CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe chronic lung diseases in which air flow is obstructed by emphysema, chronic
bronchitis, refractory (irreversible) asthma, and severe bronchiectasis.
*In each condition there is chronic obstruction of the flow of air through the airways and out of the lungs, and the obstruction generally is usually progressive &
irreversible and & it may be associated with air-way hyperactivity. Progressive means the disease gets worse over time. Other names for COPD are Chronic
Obstructive Lung Disease (COLD), Chronic Air-Flow Limitation (CAL) or Chronic Lower Respiratory Disease (CLRD)
*In COPD, less air flows in and out of the airways because of one or more of the following
*The airways and air sacs lose their elastic quality.
*The walls between many of the air sacs are destroyed.
*The walls of the airways become thick and inflamed.
*The airways make more mucus than usual, which tends to clog them.
RISK FACTOR
1. CIGARETTE SMOKING
2. PASSIVE SMOKING
3. FAMILY HISTORY
4. GENETIC ABNORMALITIES DEFICIENCY OF ALPHA ANTITRYPSIN ENZYME
5. AMBIENT AIR POLLUTION
6. OCCUPATIONAL EXPOSURE
PATHOPHYSIOLOGY
Chronic obstructive pulmonary disease (COPD) is a mixture of 3 separate disease pro- cesses. These processes are chronic bronchitis, emphysema and, to a lesser
extent, asthma. Progression of COPD is characterized by the accumulation of inflammatory mucous exu- dates in the lumens of small airways and the thickening
of their walls.
1. Due to causes and risk factors of the COPD
2. Affects ciliary cleaning mechanism of respiratory tract
3. Airflow is obstructed & air becomes trapped 4.behind the obstruction
5. Alveoli greatly distend & lung capacity decreased
6. Increased accumulation of the mucus from mucus glands
7. Produce more irritation, infection
8. Damage to Lungs
STAGE OF COPD
I MILD COPD
II MODERATE COPD
III SERVER COPD
CLINICAL MANIFESTATIONS
*Increased work of breathing
*Tightness in the chest
*Decreased exercise tolerance
*Prolonged expiration
*Pitting peripheral edema
*Wheezing
*Weight loss
*Respiratory insufficiency
*Tachypnea
*Fatigue
*Production of purulent (cloudy and discolored) sputum
*Enlarged A.P. diameter of chest
*Chronic Coughing (productive with sputum
*Shortness of breath (dyspnea)
*Frequent respiratory infections
*Production of purulent (cloudy and discolored) sputum
*Chronic Coughing (productive with sputum
*Shortness of breath (dyspnea)
*Frequent respiratory infections
*Acute & chronic respiratory failure
*Advanced COPD symptoms
In advanced COPD, patients may develop cyanosis (bluish discoloration of the lips and nail beds) due to a lack of oxygen in blood.
*They also may develop morning headaches due to an inability to remove carbon dioxide from the blood.
*Weight loss occurs in some patients, primarily (another possibility is reduced intake of food) because of the additional energy that is required to breathe.
*Patients with COPD may cough up blood (hemoptysis). Usually hemoptysis is due to damage to the inner lining of the airways and the airways’ blood vessels.
*Swollen feet and ankles can occur due to increased stress on the heart, which has to work harder to pump blood to the damaged lungs.
DIAGNOSTIC EVALUATIONS
*COPD usually is first diagnosed on the basis of a medical history which discloses many of the symptoms of COPD and a physical examination which discloses
signs of COPD. Doc- tor may ask whether patient smoke or have had contact with lung irritants, such as second- hand smoke, air pollution, chemical fumes, or
dust. Doctor will examine and use a stethoscope to listen for wheezing or other abnormal chest sounds. Other tests to diagnose COPD include chest X-ray,
computerized tomography (CAT or CT scan) of the chest, tests of lung function (pulmonary function tests) and the measurement of carbon dioxide and oxygen
levels in the blood.
*Lung Function Tests: Lung function tests measure how much air person can breathe in and out, how fast he/she can breathe air out, and how well lungs deliver
oxygen to blood. There are four components to pulmonary function testing: spirometry, postbronchodilator spirometry, lung volumes, and diffusion capacity. In
the initial evaluation, all four components are often performed. Periodically, an individual component, most commonly spirometry, is performed to assess
progression of disease and to determine the effectiveness of medication.
*Chest x ray or chest CT scan: These tests create pictures of the structures inside chest, such as heart, lungs, and blood vessels. The pictures can show signs of
COPD. They also may show whether another condition, such as heart failure, is causing symptoms.
*Arterial Blood Gas Analysis: This test measures how well lungs are doing in transfer- ring oxygen into blood and in removing carbon dioxide from it.
*Pulse Oximetry: A less invasive method to measure oxygen levels in the blood is called pulse oximetry. A probe (oximeter) is placed around a fingertip to
measure the percentage of oxygen saturation in the blood.
*Alpha-1-Antitrypsin Level: A person suspected of having a genetic deficiency of this enzyme will undergo this test. Alpha-1-antitrypsin deficiencies can also
cause liver dis- ease in children, and the level may be measured for that as well. If the level is low, a genetic probe may be used to determine the cause.
MEDICAL MANAGEMENT
The goals of COPD treatment are:
*To prevent further deterioration in lung function
*To alleviate symptoms
*To improve performance of daily activities and quality of life
The treatment strategies include:
1. Quitting cigarette smoking
2. Taking medications to dilate airways (bronchodilators) and decrease airway inflammation
3. Vaccination against flu influenza and pneumonia
4. Regular oxygen supplementation; and
5. Pulmonary rehabilitation.
SURGICAL MANAGEMENT
1. BULLECTOMY
2. LUNG VOLUME REDUCTION SURGERY
3. LUNG TRANSPLANT
NURSING DIAGNOSIS
1. Ineffective Airway Clearance related to bronchoconstriction, increased mucus produc- tion, ineffective cough, and possible bronchopulmonary infection.
2. Impaired Gas Exchange related to decreased ventilation, chronic pulmonary obstruction, abnormalities due to destruction of alveolar capillary membrane.
3. Ineffective Breathing Pattern r/t shortness of breath, mucus, bronchoconstriction, and airway irritants.
4. Imbalanced Nutrition: Less Than Body Requirements related to increased work of breath- ing, air swallowing, drug effects with resultant wasting of respiratory
and skeletal muscles
5. Activity Intolerance r/t fatigue, inadequate oxygenation & dyspnea 6. Anxiety r/t acute breathing difficulties & fear of suffocation
7. Deficient Knowledge regarding condition, treatment, self-care, and discharge needs re- lated to lack of information or unfamiliarity with information resources,
Information misinterpretation, Lack of recall or cognitive limitation.