1COPD AND ACUTECOPD AND ACUTERESPIRATORYRESPIRATORYFAILUREFAILURE
22Anatomy of Lower RespiratoryAnatomy of Lower RespiratoryTractTract
3MEANINGOFCHRONIC OBSTRUCTIVE PULMONARYDISEASE• .• Chronic obstructive pulmonary disease is agroup of progressive obstructive lung disorderwhere airway resistance is increased withreduced airflow ;may include diseases thatcause airflow limitation (eg emphysema,chronic bronchitis , bronchiectasis )or acombination of this disorder.[older definition]
MEANINGMEANINGOFOFCHRONIC OBSTRUCTIVE PULMONARY DISEASECHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic obstructive pulmonary disease isChronic obstructive pulmonary disease isa disease state characterrised by airflowa disease state characterrised by airflowlimitation that is not fullyreversible.limitation that is not fullyreversible. (NIH,2001 and GOLD 2002)(NIH,2001 and GOLD 2002)( Newer definition)( Newer definition)4
RISK FACTORS FOR CHRONICRISK FACTORS FOR CHRONICOBSTRUCTIVE PULMONARY DISEASE.OBSTRUCTIVE PULMONARY DISEASE. Exposure to tobacco smoke accounts forExposure to tobacco smoke accounts forestimated 80% tp 90% of COPD).estimated 80% tp 90% of COPD). Passive smoking.Passive smoking. Occupational exposure.Occupational exposure. Ambient air pollution.Ambient air pollution. Genetic abnormalities, including a deficiencyGenetic abnormalities, including a deficiencyof alfhpa1- antitrypsin,an enzyme inhibitorof alfhpa1- antitrypsin,an enzyme inhibitorthat normally counteracts the destruction ofthat normally counteracts the destruction oflung tissue by certain other enzymeslung tissue by certain other enzymes5
77PathophysiologyPathophysiologyPathologic changes in the lung consists of:Pathologic changes in the lung consists of:1.1. Hyperplasia of mucous secreting glandsHyperplasia of mucous secreting glandsin the trachea and bronchiin the trachea and bronchi2.2. Disappearance of ciliaDisappearance of cilia3.3. Chronic inflammatory changes andChronic inflammatory changes andnarrowing of small airways.narrowing of small airways.4.4. Altered function of alveolar macrophagesAltered function of alveolar macrophagesleading to increased bronchial infections.leading to increased bronchial infections.
8CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS► Frequent productive coughFrequent productive cough► Broncho -spasm occur at the end of paroxysm ofBroncho -spasm occur at the end of paroxysm ofcoughing.coughing.► Frequent respiratory infectionsFrequent respiratory infections► Dyspnea on exertionDyspnea on exertion► Weight- normal or heavy setWeight- normal or heavy set► Hypoxemia and hypercapniaHypoxemia and hypercapnia► Blue bloaterBlue bloater► PolycythemiaPolycythemia► cyanosiscyanosis
1111Medical management of COPDMedical management of COPD Treatment goals:Treatment goals:1.1. Improve ventilationImprove ventilation2.2. To facilitate the removal of bronchialTo facilitate the removal of bronchialsecretionssecretions3.3. To prevent complicationsTo prevent complications4.4. To slow the progression of clinicalTo slow the progression of clinicalmanifestations.manifestations.5.5. To promote health maintenanceTo promote health maintenance
1515Control complicationsControl complications Edema and cor pulmonale areEdema and cor pulmonale aretreated with diuretics and digitalistreated with diuretics and digitalis Phlebotomy to reduce blood volumePhlebotomy to reduce blood volume
16Improve general health Stop smoking Minimize exposure to allergens Avoid high altitudes Adequate nutrition
2222Nursing managementNursing management 1. Nursing Assessment:1. Nursing Assessment:Subjective data (health information,Subjective data (health information,functional health pattern)functional health pattern)Objective data (Head to foot examination)Objective data (Head to foot examination)
2323Nursing diagnosis & interventionsNursing diagnosis & interventions1.1. In effective air way clearance R/TIn effective air way clearance R/Texpiratory air flow obstruction.expiratory air flow obstruction. Maintain adequate hydrationMaintain adequate hydration Effective coughing techniques.Effective coughing techniques.
24Nsg. management cont….2. Impaired gas exchange R/Tdecreased ventilation and mucusplugs. Monitor client’s respiratory rate,pattern, ABG results Administer low flow oxygen High fowlers position Administer broncho dilators
25Cont..Cont..► Teach s/s and consequences of hyper capniaTeach s/s and consequences of hyper capnia► Avoid CNS depressant drugsAvoid CNS depressant drugs3. Anxiety R/T acute breathing difficulty.3. Anxiety R/T acute breathing difficulty. Remain with the client during the episodes ofRemain with the client during the episodes ofbreathing difficultybreathing difficulty Provide calm, quiet environment.Provide calm, quiet environment. Ensure ventilationEnsure ventilation Administer sedatives with caution (nonAdminister sedatives with caution (nonpharmaceutical methods of anxiety reduction)pharmaceutical methods of anxiety reduction)
2626Nursing Mx.cont….Nursing Mx.cont….4. Activity intolerance R/T inadequate4. Activity intolerance R/T inadequateoxygenation and dyspnea.oxygenation and dyspnea. Monitor the severity of dyspnea and O2Monitor the severity of dyspnea and O2saturation following activity.saturation following activity. Stop or slow activity that leads to significantStop or slow activity that leads to significantchange in respiration.change in respiration. Maintain supplemental O2Maintain supplemental O2 Schedule active exercise after resp. therapy.Schedule active exercise after resp. therapy.
27Cont…Assist the client in scheduling gradualincrease in daily activities.Avoid conditions that increase O2demand.Teach effective breathing techniques.Instruct the client in energyconservation techniques.
2828Cont….Cont….5. Altered nutrition less than body5. Altered nutrition less than bodyrequirements R/T reduced appetite,requirements R/T reduced appetite,decreased energy level and dyspnea.decreased energy level and dyspnea.Mouth care before meals.Mouth care before meals.Small, frequent meals high in protein &Small, frequent meals high in protein &calories.calories.Avoid gas producing foodAvoid gas producing foodMonitor the clients food intake, weight andMonitor the clients food intake, weight andserum Hb, albumin levels.serum Hb, albumin levels.
2929Cont…Cont…6. Disturbed sleep pattern R/T dyspnea and6. Disturbed sleep pattern R/T dyspnea andexternal stimuli.external stimuli.Promote relaxation.Promote relaxation.Schedule care activities to allow periods ofSchedule care activities to allow periods ofuninterrupted sleep.uninterrupted sleep.Avoid use of sleeping pills.Avoid use of sleeping pills.Avoid stimulants e.g. caffeineAvoid stimulants e.g. caffeineMaintain a consistent bed time and aMaintain a consistent bed time and aregular bed time routine.regular bed time routine.Recliner chair may be better in dyspnea.Recliner chair may be better in dyspnea.
3030Cont….Cont….7. Interrupted family process R/T chronic illness of a7. Interrupted family process R/T chronic illness of afamily member.family member. Encourage participation of family members in theEncourage participation of family members in theplanning process.planning process. Family counseling if needed.Family counseling if needed. Encourage social support network.Encourage social support network. Provide family with anticipatory guidance.Provide family with anticipatory guidance.
3131Cont…Cont…8. Risk for infection R/T ineffective8. Risk for infection R/T ineffectivepulmonary clearance.pulmonary clearance. Hand washing after contacting withHand washing after contacting withthe potentially infectious material.the potentially infectious material. Teach the client how to care forTeach the client how to care forrespiratory equipments used atrespiratory equipments used athome.home. Teach the client and the family theTeach the client and the family themanifestations of pulmonarymanifestations of pulmonaryinfections.infections.
3232Cont…..Cont…..9. Sexual dysfunction R/T dyspnea, reducedenergy.Provide opportunity for the client todiscuss concerns.Suggest measures that may facilitatesexual activityEncourage alternative forms of sexualexpression
3333Cont…..Cont…..10. Decisional conflict R/T smoking10. Decisional conflict R/T smokingcessationcessation Assess clients readiness to atop smokingAssess clients readiness to atop smoking Counseling and pharmaco therapyCounseling and pharmaco therapy Arrange follow up care.Arrange follow up care.
3434Cont….Cont….11. Impaired physical mobility R/T de-11. Impaired physical mobility R/T de-conditioning.conditioning. Use adaptive breathing techniqueUse adaptive breathing techniqueduring activity to decrease the workduring activity to decrease the workof breathing.of breathing. Space the activities.Space the activities. Gradual increase of activities.Gradual increase of activities. Methods of conserving energy.Methods of conserving energy. Active and passive exercise toActive and passive exercise tomaintain adequate muscle mass.
3535Patient education and homecare.Patient education and homecare.1.1. Teach adaptive breathing techniquesTeach adaptive breathing techniques2.2. Airway clearance techniqueAirway clearance technique3.3. Avoid contact with persons who haveAvoid contact with persons who haveURTI.URTI.4.4. Importance of prescribed medicationsImportance of prescribed medications5.5. Teach the family how to manage duringTeach the family how to manage duringacute attacks of dyspnea.acute attacks of dyspnea.6.6. Report any change in the health status.Report any change in the health status.
37Complications of COPDComplications of COPD1)1) Cor pulmonaleCor pulmonale2)2) Acute exacerbation of Chronic BronchitisAcute exacerbation of Chronic Bronchitis3)3) Peptic ulcer and gastro-esophagealPeptic ulcer and gastro-esophagealrefluxreflux4)4) Acute respiratory failureAcute respiratory failure
3838Nursing interventionsNursing interventions Promote effective airway clearance and gasPromote effective airway clearance and gasexchangeexchange Prevent complications of immobilityPrevent complications of immobility Monitoring and documenting altered tissueMonitoring and documenting altered tissueperfusionperfusion Promote effective breathing patternPromote effective breathing pattern Reduce anxietyReduce anxiety Promote comfort.Promote comfort.