Presentation adv practice 1


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Presentation adv practice 1

  1. 1. Obstructive Lung Disease <ul><ul><ul><ul><li>KimberlyAugustine BSRN </li></ul></ul></ul></ul>
  2. 2. Objectives <ul><li>Define Obstructive Lung Disease </li></ul><ul><li>Epidemiology </li></ul><ul><li>Pathophysiology </li></ul><ul><li>Identify Clinical manifestations </li></ul><ul><li>Identify Risk factors </li></ul><ul><li>Discuss Evaluation & Treatment </li></ul>
  3. 3. Definition <ul><li>Several different definitions have existed for COPD. </li></ul><ul><li>“ A disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.”-GOLD </li></ul><ul><li>A group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema, chronic bronchitis, and in some cases asthma.-CDC </li></ul><ul><li>“ Airway obstruction:most common obstructive diseases are asthma, chronic bronchitis, emphysema-McCane & Huether </li></ul>
  4. 4. Obstructive Pulmonary Disease <ul><li>Obstructive Diseases </li></ul><ul><li>Include: </li></ul><ul><li>Chronic bronchitis </li></ul><ul><li>Emphysema </li></ul><ul><li>Asthma </li></ul>
  5. 5. Epidemiology <ul><li>4th leading cause of death in the U. S. </li></ul><ul><li>12.1 million U.S. adults were estimated to have COPD </li></ul><ul><li>Women have exceeded men in the number of deaths attributable to COPD </li></ul><ul><li>2010, $49.9 billion COPD health care costs </li></ul><ul><li>Worldwide leading cause of death & disability </li></ul><ul><li>2020, predicted 3 rd leading cause of death </li></ul>
  6. 6. Pathophysiology: Video <ul><li> </li></ul>
  7. 7. Obstructive Lung Disease: Emphysema <ul><li>“ A condition which the lungs lose elasticity and alveoli enlarge that disrupts function” </li></ul><ul><li>Destruction of lung parenchyma </li></ul><ul><li>Loss of elastic recoil </li></ul><ul><li>Alveolar gas is trapped in expiration </li></ul><ul><li>Gas exchange is compromised </li></ul>
  8. 8. Pathophysiology: Emphysema <ul><li>Begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. </li></ul><ul><li>The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent &quot;holes&quot; in the tissues of the lower lungs. </li></ul><ul><li>As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath. </li></ul><ul><li>The lungs also lose their elasticity, which is important to keep airways open. The patient experiences great difficulty exhaling. </li></ul>
  9. 9. COPD: Emphysema
  10. 10. COPD: Emphysema Signs & Symptoms <ul><li>Dyspnea </li></ul><ul><li>Little sputum production or cough </li></ul><ul><li>Tachypnea with prolonged expiration </li></ul><ul><li>Use of accessory muscles for ventilation </li></ul><ul><li>Increased anteroposterior diameter of thorax (Barrel Chest) </li></ul><ul><li>Pierced Lips to prevent expiratory airway collapse </li></ul><ul><li>Cardiac enlargement </li></ul><ul><li>Hyperresonant (loud, low) sound with chest percussion d/t hyperinflation </li></ul>
  11. 11. Obstructive Lung Disease: Chronic Bronchitis <ul><li>“ The presence of a mucus-producing cough three months of a year for two consecutive years without other underlying disease to explain the cough.” </li></ul><ul><li>Inflammation and eventual scarring of the lining of the bronchial tubes </li></ul><ul><li>Inflamed, infected bronchi allow for less air to flow to and from the lungs and a heavy mucus or phlegm is coughed up </li></ul>
  12. 12. Pathophysiology: Chronic Bronchitis <ul><li>Increased mucous production </li></ul><ul><li>Increase in size, number goblet cells </li></ul><ul><li>Impaired Ciliary function </li></ul><ul><li>Bronchospasm, permanent narrowing of airways </li></ul><ul><li>Decreased ventilation </li></ul><ul><li>Tidal Volume Decreased </li></ul><ul><li>Hypoventilation </li></ul><ul><li>Hypercapnia </li></ul>
  13. 13. COPD: Chronic Bronchitis
  14. 14. COPD: Chronic Bronchitis Signs & Symptoms <ul><li>Wheezing and shortness of breath </li></ul><ul><li>Productive cough “smoker's cough” </li></ul><ul><li>Decreased tolerance, hypoxic with exercise </li></ul><ul><li>Frequent pulmonary infections </li></ul><ul><li>Decreased FEV1, FEC </li></ul><ul><li>FRC & RV increased </li></ul><ul><li>Increased Paco2, Hypoxemia, Polycythemia </li></ul><ul><li>Cyanosis “Blue Bloater” </li></ul>
  15. 15. Risk Factors: COPD (Emphysema & Chronic Bronchitis) <ul><li>Smoking predominant Cause </li></ul><ul><li>Alpha-1antitrypsin deficiency </li></ul><ul><li>Occupational exposure, pollution </li></ul><ul><li>Diet deficient in vitamin C </li></ul><ul><li>Low Birth weight </li></ul><ul><li>Childhood respiratory infections </li></ul><ul><li>Pre-existing bronchial hyper-responsiveness </li></ul><ul><li>Low social class </li></ul>
  16. 16. Global Initiative: COPD
  17. 17. Potential Complications: COPD <ul><li>Hypoxemia (paO2 of 55mmHg or less with an oxygen saturation of 85% or less) </li></ul><ul><li>Cor Pulmonale (Right Sided Heart Failure) </li></ul><ul><li>Respiratory Acidosis & Hypercapnia (increased paCO2): </li></ul>
  18. 18. Oxyhemoglobin Dissociation Curve <ul><li>The oxyhemoglobin dissociation curve is an important tool for understanding how our blood carries and releases oxygen. Specifically, the oxyhemoglobin dissociation curve relates oxygen saturation (SO 2 ) and partial pressure of oxygen in the blood (PO 2 ), and is determined by what is called &quot;hemoglobin's affinity for oxygen,&quot; that is, how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue. </li></ul>
  19. 19. Potential Complications: COPD <ul><li>Hypoxemia (paO2 of 55mmHg or less with an oxygen saturation of 85% or less) </li></ul><ul><ul><li>Mood changes </li></ul></ul><ul><ul><li>Forgetfulness </li></ul></ul><ul><ul><li>Inability to concentrate </li></ul></ul><ul><ul><li>Cyanosis a late sign of hypoxia </li></ul></ul>
  20. 20. Potential Complications of COPD <ul><li>Respiratory Acidosis & Hypercapnia (inc. pCO2): </li></ul><ul><ul><li>Decrease in oxygen/carbon dioxide exchange </li></ul></ul><ul><ul><li>Rising carbon dioxide levels result in respiratory acidosis (CO2 makes ACID) </li></ul></ul><ul><ul><li>SOB (increased Respiratory rate) </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>Lethargy </li></ul></ul><ul><ul><li>Nausea and Vomiting </li></ul></ul>
  21. 21. Potential Complications COPD <ul><li>Cor Pulmonale (Right Sided Heart Failure) </li></ul><ul><ul><li>Progressive shortness of breath with activity </li></ul></ul><ul><ul><li>Chest pain under sternum </li></ul></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><li>Neck vein distention, edema </li></ul></ul><ul><ul><li>Enlarged liver </li></ul></ul><ul><ul><li>Right ventricular hypertrophy </li></ul></ul>
  22. 22. Obstructive Lung Disease: Asthma <ul><li>“ Chronic inflammatory disorder of the airways involving hyper-responsiveness and airway obstruction” </li></ul><ul><li>Periods of attacks of wheezing shortness of breath </li></ul><ul><li>Tight feeling in the chest </li></ul><ul><li>Cough that produces mucous </li></ul><ul><li>Due to an allergic reaction </li></ul><ul><li>Triggered by certain drugs, irritants, viral infection, exercise emotional stress </li></ul>
  23. 23. Pathophysiology: Asthma <ul><li>Familial </li></ul><ul><li>Allergen Exposure initiates immune response </li></ul><ul><li>IL-4 activates IgE production, mast cell degranulation </li></ul><ul><li>Releases histamine, prostaglandins, leukotrienes </li></ul><ul><li>Bronchospasm, congestions, mucous production </li></ul><ul><li>Bronchial Hyper-responsiveness </li></ul>
  24. 24. Asthma: Signs & Symptoms <ul><li>Asymptomatic between attacks </li></ul><ul><li>Chest constriction </li></ul><ul><li>Expiratory Wheezing </li></ul><ul><li>Dyspnea </li></ul><ul><li>Non productive cough </li></ul><ul><li>Tachycardia, tachypnea </li></ul><ul><li>Pulsus Paradoxus </li></ul>
  25. 25. Asthma: Signs & Symptoms (Cont.) <ul><li>Hypoxemia with low pCO2 </li></ul><ul><li>Respiratory fatigue/failure: pco2 may rise </li></ul><ul><li>Eosinophilia (allergy) </li></ul><ul><li>Decreased FEV1 </li></ul><ul><li>Decreased peak expiratory flow rate </li></ul>
  26. 26. Risk Factors: Asthma
  27. 27. Asthma: EvaluationTreatment <ul><li>Treat precipitating event </li></ul><ul><li>Oxygen therapy </li></ul><ul><li>Hydration </li></ul><ul><li>Antibotics (with infection) </li></ul><ul><li>Meds: bronchodilators, steroids, mast cell stabilizers, methylxanthines </li></ul>
  28. 28. Nursing Diagnosis: COPD <ul><li>Ineffective airway clearance r/t </li></ul><ul><ul><li>Airway spasm </li></ul></ul><ul><ul><li>Retained secretions </li></ul></ul><ul><ul><li>Excessive mucous </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><li>Impaired gas exchange r/t </li></ul><ul><ul><li>Descreased lung expansion </li></ul></ul><ul><ul><li>Decreased LOC </li></ul></ul><ul><ul><li>Presence of pulmonary secretions </li></ul></ul>
  29. 29. Nursing Diagnosis: COPD <ul><li>Ineffective breathing patterns r/t </li></ul><ul><ul><li>Hyperventilation </li></ul></ul><ul><ul><li>Hypoventilation </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>fatigue </li></ul></ul>
  30. 30. Planning (Goals) <ul><li>Breath sounds clear A&P </li></ul><ul><li>Respirations between 12-20/min </li></ul><ul><li>SaO2 90% or greater </li></ul><ul><li>Ambulate ___ feet QID </li></ul>
  31. 31. Implementation: Promoting Lung expansion <ul><li>Positioning </li></ul><ul><li>Breathing exercises </li></ul><ul><li>Chest Physiotherapy </li></ul><ul><li>Oxygen Therapy </li></ul>
  32. 32. Implementation: Promoting Lung expansion <ul><li>Positioning: change at least Q2 hrs </li></ul>
  33. 33. Implementation: Promoting Lung expansion <ul><li>Breathing exercises: to expel secretions from lungs </li></ul><ul><ul><li>CDB Q2 hrs </li></ul></ul><ul><ul><li>Pursed lip breathing </li></ul></ul><ul><ul><ul><li>Helps COPD patients to evacuate more air by breathing out against pressure </li></ul></ul></ul><ul><ul><li>Abdominal Breathing (diaphragmatic) </li></ul></ul><ul><ul><ul><li>Promotes alveoli expansion and emptying </li></ul></ul></ul>
  34. 34. Implementation: Mobilizing Pulmonary Secretions <ul><li>Hydration </li></ul><ul><ul><li>Keeps pulmonary secretions moist, easy to expectorate </li></ul></ul><ul><ul><li>Fluid intake 1500-2000 cc/day </li></ul></ul><ul><li>Humidification </li></ul><ul><ul><li>Air or oxygen with increased humidity will help to keep airways moist to loosen and mobilize pulmonary secretions </li></ul></ul><ul><li>Nebulization </li></ul><ul><ul><li>Adding fine drops of moisture to the respiratory tract </li></ul></ul>
  35. 35. Implementation: Mobilizing Pulmonary Secretions <ul><li>Chest physiotherapy </li></ul><ul><ul><li>Chest percussion (cupping) </li></ul></ul><ul><li>Vibration: fine shaking pressure applied to chest wall only during exhalation (helps get rid of trapped air) vest </li></ul>
  36. 36. Implementation: Mobilizing Pulmonary Secretions <ul><li>Chest physiotherapy </li></ul><ul><ul><li>Postural Drainage: positioning </li></ul></ul><ul><ul><li>(not good for emphysema/bronchitis don’t tolerate asthma not needed. Just for CF-bronchitis w/o emphesema </li></ul></ul>
  37. 37. Case Study
  38. 38. Journal Article: COPD the role of the nurse by Barnett <ul><li>Nurses have a key role in the prevention and treatment of COPD in advising and supporting patients living with this condition. </li></ul>
  39. 39. Nurses Role <ul><li>Prevention & Treatment </li></ul><ul><ul><li>Recognize clinical symptoms </li></ul></ul><ul><ul><li>Recognize Associated Risk Factors </li></ul></ul><ul><ul><li>Medications Available </li></ul></ul><ul><ul><ul><li>Effectiveness(Questions) </li></ul></ul></ul><ul><ul><li>Patient Education: </li></ul></ul><ul><ul><ul><li>Smoking </li></ul></ul></ul><ul><ul><ul><li>Nutrition </li></ul></ul></ul><ul><ul><ul><li>Activity </li></ul></ul></ul><ul><ul><ul><li>Vaccination </li></ul></ul></ul>
  40. 40. Discussion <ul><li>Patient Factors for COPD/Single Most Factor </li></ul><ul><li>Clinical Manifestations of Bronchitis/Emphysema </li></ul><ul><li>COPD Staging </li></ul><ul><li>Arterial Blood Gas indicative of which Serious Condition </li></ul><ul><li>Pulmonary HTN/Cor Pulmonale Clinical Manifestations </li></ul>
  41. 41. Restrictive vs Obstructive Disease <ul><li>http:// = wbcjFpyxkpc&feature =related </li></ul>
  42. 42. References <ul><li>Barnett, Margaret.  (2006, February). COPD: the role of the nurse. Journal of Community Nursing, 20(2), 18-20,22.  Retrieved October 26, 2010, from Research Library. (Document ID: 989426231). </li></ul><ul><li>Bauldoff, G. (2009). When breathing is a burden: how to help patients with COPD. American Nurse Today, 4(9), 17-22. Retrieved from CINAHL database. </li></ul><ul><li>National Heart Lung and Blood Institute . </li></ul><ul><li>American Lung Association </li></ul>