ASK the learners what they think the causes/contributing factors might be .
ASK the learners. Go back to the breath through the closed hand exercise to discuss s/s .
Copd imp د. جيهان
Chronic obstructivepulmonary disease (( COPD Dr. gehan younisLecturer of critical care Nursing
COPD Out lines What is the COPD? Overview Causes of COPD Symptoms of COPD Whats the difference between COPD and asthma? Diagnostic tests needed for COPD Medical management of COPD Preventive measures Nursing intervention
COPD Definition COPD , or chronicobstructive pulmonarydisease, is a progressivedisease that makes it hardto breathe. "Progressive"means the disease getsworse over time.
COPD is a collective name for chronic bronchitis and emphysema, two diseases that are almost always caused by smoking. Many of the symptoms of COPD are similar to those of asthma (e.g. breathlessness, wheezing, production of too much mucus, coughing).
COPD is a more serious disease than asthma, because the changes in the airways are much more difficult to treat, and it usually has a worse outcome. COPD can cause greater long-term disability and have a greater effect on the heart and other organ systems than asthma.
COPD: disease due to emphysema or chronic bronchitis characterized by airflow limitation that is not fully reversible
COPD Overview 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.
Emphysema Description Abnormal permanent enlargement of the air space distal to the terminal bronchioles Accompanied by destruction of bronchioles
Chronic Bronchitis Description Presence of chronic productive cough for 3 or more months in each of 2 successive years in a patient whom other causes of chronic cough have been excluded
COPD Causes Exposure to pipe, cigar, tobacco smoke Exposure to second hand smoke Exposure to heavy air pollution Exposure to heavy dust Exposure to chemical/toxic fumes Genetic conditions
Infection Major contributing factor to the aggravation and progression of COPD Heredity α -Antitrypsin (AAT) deficiency (produced by liver and found in lungs).this protien protect lung tissue from ensymz of inflamatory cells Normal from 1.5-3.5 gL Emphysema results from lysis of lung tissues by proteolytic enzymes from neutrophils and macrophages
Pathogenesis of COPD NOXIOUS AGENT(tobacco smoke, pollutants, occupational agent) Genetic factors Respiratory infection Other COPD
Pathophysiology of Chronic(Bronchitis and Emphysema(COPD Fig. 28-7
COPD Symptoms Productive cough Breathlessness Chest infection Other symptoms of COPD weight loss, tiredness and ankle swelling.
Signs and symptoms Wheezing Coughing Sputum production Shortness of breath Chest tightness
Difference between COPD and Asthma In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are chronic (persistent). Treatment to open up the airways, is therefore limited. In asthma there is inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well. COPD is more likely than asthma to cause a chronic (ongoing) cough with sputum.
Difference between COPD and asthma …((cont Night time waking with breathlessness or wheeze is common in asthma and uncommon in COPD. COPD is rare before the age of 35 whilst asthma is common in under-35.
COPD Diagnostic tests Symptoms Physical examination Sample of sputum Chest x-ray High-resolution CT (HRCT scan) Pulmonary function test (spirometery) Arterial blood gases test Pulse oximeter
Objectives of COPD Management Prevent disease progression Relieve symptoms Improve exercise tolerance Improve health status Prevent and treat exacerbations Prevent and treat complications Reduce mortality Minimize side effects from
COPD Medical management Give antibiotics to treat infection Give bronchodilators to relieve bronchospasm, reduce airway obstruction, mucosal edema and liquefy secretions. Chest physiotherapy and postural drainage to improve pulmonary ventilation. Proper hydration helps to cough up secretions or tracheal suctioning when the patient is unable to cough. Steroid therapy if the patient fails to respond to more conservative treatment.
COPD …( Medical management (cont S top smoking O xygenation with low concentration during the acute episodes In asthma adrenaline ( epinephrine) SC if the bronchospasm not relieved. A minophylins IV if the above treatment does not help. IV corticosteroids for patients with chronic asthma or frequent attack. S edative or tranquilizers to calm the patient. I ncrease fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation. I ntubations and mechanical ventilation if there is respiratory failure .
COPD Preventive measures To prevent irritation and infection of the airways, instruct the patient to: Avoid exposure to cigarette, pipe, and cigar smoke as well as to dusts and powders. Avoid use of aerosol sprays. Stay indoors when the pollen count is high. Stay indoors when temperature and humidity are both high
COPD …(Preventive measures (cont Use air conditioning to help decrease pollutants and control temperature Avoid exposure to persons known to have colds or other respiratory tract infection Avoid enclosed, crowded areas during cold and flu season. Obtain immunization against influenza and streptococcal pneumonia.
COPD …(Preventive measures (cont To ensure prompt, effective treatment of a developing respiratory infection, instruct the patient to do the following:- Report any change in sputum color character, increased tightness of the chest, increased dyspnea, or fatigue. Call the physician if ordered antibiotics do not relieve symptoms within 24
COPD Nursing intervention Assessment History Patients environment Work history, exercise pattern, smoking habits The onset & development of symptoms Sleeping positions
COPD …(Nursing intervention (cont Physical examinationSigns of heavy smokers Observe for clubbing Distended neck vein on expiration The presence of barrel chest Observe for abdominal breathing The use of pursed lips breathing and chest movement Auscultate the chest& listen for musical wheezes characteristics of chronic bronchitis
COPD …(Nursing intervention (cont review the results of diagnostic procedure: Arterial blood gases Pulmonary function tests X-ray films Nursing diagnosis Ineffective breathing pattern related to increase need of O2 Ineffective airway clearance related to excessive accumulation of secretions Impaired gas exchange related to impaired expiration &co2 retention
COPD …(Nursing intervention (cont Activity intolerance related to inadequate oxygenation High risk for ineffective individual coping related to chronic disease, its effects& its treatment High risk for altered health maintenance related to insufficient knowledge of prevention, identification and treatment of respiratory complication of COPD
Warning symptoms Increasing shortness of breath Increasing coughing and wheezing History of fever
Warning signs* Increased wheezing Decreased pulse ox Fever ( greater than 101 degrees Fahrenheit) Increased pulse (greater than 100) Decreased pulse (less than 60) Increased respiratory rate*ALL vital parameters are determined by RN supervisor and are patient specific