Chronic Obstructive pulmonary diasese
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The document discusses chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive lung disease characterized by airflow obstruction caused by chronic bronchitis or emphysema. The document provides statistics on the prevalence and mortality of COPD worldwide and in India. It identifies the major risk factors, clinical manifestations, diagnostic evaluations, management including medications, oxygen therapy, surgery, and rehabilitation. It also discusses nursing care for patients with COPD.
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Chronic Obstructive pulmonary diasese
- 2. DEFINITION COPD is a disease state characterized by the presence of airflow obstruction caused by chronic Bronchitis or emphysema. The airflow obstruction is generally progressive, may be accompanied by airway hyperactivity, and may be partially reversible.
- 3. Dr.Sarma@works 3 CHRONIC OBSTRUCTIVE LUNG DISEASES COPD REVERSIBILITY OF AIR WAY OBSTRUTION NONE EMPHYSEMA CHRONIC BRONCHITIS
- 4. 4 PREVALENCE of MORTALITY • In 2000, the WHO estimated 2.74 million COPD deaths worldwide. • In 1990, COPD was ranked 12th leading cause of death. • It is expected to be the third leading cause of death by 2020. • 10 lacs Indians die in a year due to smoking related diseases. • In India, 4,00,000 premature deaths annually due to use of biomass fuels, like cow dung cakes, open fires Cause Deaths CHD 724,269 Cancer 534,947 CVA 158,060 COPD 1,14,318 Accidents 94,828 Diabetes 64,574 (2000) *The Indian J Chest Dis & Allied Sciences 2009; 43:139-47
- 5. 5 PREVALENCE of MORBIDITY • Cigarette smoking is the primary cause. • WHO estimates 1.1 Billion smokers in world. • In India 1,49,00,000 chronic cases of COPD in the age group of 30 Year Consultations 1980 6.1 million 1985 7.4 million 1990 10.1 million 1995 11.8 million 2000 13.9 million 2025 ↑↑ 1.6 billion ?
- 6. 4000 chemicals (more than 60 carcinogens) are inhaled in cigarette smoke
- 7. Dr.Sarma@works 7 Every day 55000 Indian youth start tobacco use COLLEGE STUDENTS ( 2%) TENDER AGE GROUPS THE NUMBER OF WOMEN SMOKERS& PASSIVE SMOKERS IS ON RISE Currently there are 94 million smokers in India
- 8. 8 Risk Factors for COPD Nutrition Infections Socio-economic status Aging Populations Genes (alpha1- anti-trypsin↓)
- 10. CHRONIC BRONCHITIS Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of two Consecutive years.
- 11. EMPHYSEMA • Is a pathological term describes an abnormal distension of air spaces beyond the terminal bronchioles, with destruction of wall of alveoli.
- 15. Did you know? • The King of Pop suffered from Alpha-1 antitrypsin deficiency,
- 16. Centrilobular (central part of lobule) •Dilation and destruction of respiratory bronchioles and pulmonary capillary bed •Prominent in upper lobes Panlobular (destruction of whole lobule) •Affects respiratory bronchioles, alveolar ducts, and alveolar sacs. •Prominent in lower lobes
- 19. Clinical Manifestations • Develops slowly around 50 yrs of age after 20 pack years of cigarette smoking • Diagnosis is considered with – Cough – Sputum production – Dyspnea – Exposure to risk factors * Packets per day x Years of smoking = Pack Years
- 20. Clinical Manifestations • Intermittent Cough with expectoration • Progressive Dyspnea Described by the patient as an “increased effort to breathe,” “heaviness,” “air hunger,” or “gasping.”
- 21. Clinical Manifestations • chest breathing – Use of accessory such as those in the neck and intercostal muscles – Decreased abdominal breathing – – Purse lip breathing on expiration. It helps to prevent airway collapse by increasing pressure .
- 22. Clinical Manifestations • Barrel Chest- • Air gets trapped causing increase in antero posterior dimensions of the chest
- 23. •Poor ventilation and perfusion; unable to compensate leading to hypoxia and cyanosis •Clubbing
- 24. •Over ventilate to maintain relatively normal ABG’s •Red face
- 25. DIAGNOSTIC EVALUATION • *Percussion : • Hyperresonant • depressed diaphragm, • *Auscultation: • Prolonged expiration ； • reduced breath sounds; • The presence of wheezing during quiet breathing Crackle can be heard if infection exist.
- 26. Para clinical examination • CT: highlighting the pulmonary emphysema and emphysema bubbles. • Blood examination In excerbation or acute infection in airway, leucocytosis may be detected. • Screening for alpha 1 antitrypsin deficiency • Sputum examination streptococcus pneumonia Haemophilus influenzae klebsiella pneumonia
- 27. • 6-Minute walk test to determine O2 desaturation in the blood with exercise • ECG can show signs of right ventricular failure • ABG typical findings – Low PaO2 – ↑ PaCO2 – ↓ pH – ↑ Bicarbonate level found in late stages COPD
- 28. Spirometry
- 31. Dr.Sarma@works 31 REHABILITATION For the lungs to get more air PURSED-LIP BREATHING (like breathing out slowly into a straw) INHALE EXHALE
- 32. Dr.Sarma@works 32 1. Sit comfortably and relax your shoulders. 2. Put one hand on your abdomen. Now inhale slowly through your nose. (Push your abdomen out while you breathe in) 3. Then push in your abdominal muscles and breathe out using the pursed-lip technique. (You should feel your abdomen go down) Note: • Repeat the above maneuver three times and then take a little rest. • This exercise can be done many times a day. REHABILITATION For the lungs to get more air DIAPHRAGMATIC BREATHING Sit comfortably and relax your shoulders Put one hand on your abdomen. Now inhale slowly through your nose. (Push your abdomen out while you breathe in) Then push in your abdominal muscles and breathe out using the pursed-lip technique
- 34. Positions for Postural Drainage 34
- 35. Methods of Oxygen Administration D. Tracheostomy Mask F. Standard Nasal Cannulas C. Venturi Mask E. Face Tent 35
- 36. Simple Face Mask for Oxygen Administration Fig. 29-11 A36 Plastic Face Mask with Reservoir Bag for Oxygen Administration
- 37. DIET PLAN Calories -1300 to 1800 Kcal/day Protein - 1 gm/kg/body weight Fat - 50 gm Fibers - 30 to 35 gms Potassium rich diet Salt 10 gm/day Hydration 3 litre /day
- 38. 38 SURGERY 1. Single lung transplant 1. LVRS - Lung volume reduction surgery 1. Bullectomy
- 39. COPD Complications • Cor pulmonale • Exacerbations of COPD • Acute respiratory failure • Peptic ulcer disease • Depression/anxiety
- 40. NURSING DIAGNOSES • Impaired gas exchange related to ventilation perfusion mismatch • Ineffective breathing pattern related to bronchoconstriction. • Self care deficit (global) related to generalised weakness secondary to increased work of breathing • Sleep pattern disturbance related to breathing difficulty • Ineffective individual coping related to dyspnea, and hospitalisation.
- 41. NURSING DIAGNOSES Contd….….. • Interrupted family process related to chronic condition. • Risk for aspiration related to depressed cough/ gag reflexs, impaired swallowing or delayed gastric emptying. • Risk for infection related to ineffective pulmonary clearance • Risk for impaired skin integrity related to prolonged bed ridden. • Anxiety related to outcome of disease • Deficient knowledge regarding self management to be performed at home.
- 42. Assessment Nursing diagnosis Objective Nursing intervention Evaluation Subjective data Patient verbalises that he has breathing difficulty Objective data confused, use of accessory muscles, restless Clinical findings Dyspnoea RR 26 /mtin, Auscultation: Wheeze both lung fields Documentary evidence ABG-Resp.acidosis pH <7.35 PaCo2>45mmHg PaO2<60 mm Hg SaO2<90% at rest Impaired gas exchange related to bronchial obstruction , spasm and trapping Maintains optimum gas exchange levels. 1. Help the patient to assume position of comfort -tripod position or head end elevation with back rest- to maximise respiratory excursion and to ease work of breathing Improved mental status ,eupnoea, relaxed PaCo2of 35- 45 mm Hg Pa O2- normal 2.Administer appropriate bronchodilators as prescribed to open the airways 3.Administer oxygen as ordered through appropriate device to increase saturation 4.Plan rest and activities in such a way (pace out nursing / club procedures) to minimise tissue oxygen demands 5.Teach and demonstrate purse-lip breathing to prolong expiratory phase and to slow down the rate of respiration 6. Administer humidified oxygen and employ room humidification to mobilize secretions
- 43. Nursing assessment Nursin g diagno sis Goal Nursing interventions Evaluation Subjective data: Patient verbalizes difficulty in breathing, tiredness, not able to lie down flat and cough Objective data: Dyspnoeic grade –, shortness of breath, frequent sighs, use of accessory muscles of breathing, nasal flaring, cough Clinical findings: RR -> 24 breaths /minute Irregular breathing rhythm Increased AP diameter of chest IE ratio 2:4 Documentary evidence Respiratory acidosis Chest skiagram Consolidation of both lower lobes of lungs Ineffect ive breathi ng pattern related to decreas ed lung expansi on Main tain effect ive breat hing patte rn 1. Position patient in a semi to high Fowler’s position to promote maximum diaphragmatic descent and lung expansion. Patient verbalized less breathing difficulty Patient will maintain normal respiratory rate Regular breathing rhythm Reduction in cough No use of accessory muscles for breathing IE ratio 1:2 Normal and Spo2 > 95 % 2. Use additional pillows as needed to prevent slumping because slumping causes the abdominal contents to be pushed up against the diaphragm and restrict lung expansion. 3. Provide uninterrupted rest periods to increase strength and activity tolerance which in turn promotes participation in activities to improve breathing pattern. 4. Instruct patient to do deep breathing exercise as follows. a.)Sit up, stand or lean forward slightly while sitting on edge of bed or chair.b.)Take in a slow, deep breath c.)Pause slightly or hold breath for at least 3 secs. d.)Exhale slowlye.)Rest and repeat as tolerated. 5. Instruct patient to do pursed-lip breathing as it causes a mild resistance to exhalation, which creates positive pressure in the airways. This pressure helps prevent airway collapse and subsequently promotes more complete alveolar emptying
- 44. Assessment Nursing diagnosis Objectiv e Nursing intervention Evaluation Subjective data: Patient verbalizes that I am not able to perform daily activities Objective data: Patient is unable to perform ADL Clinical findings: Limited ROM Muscle power- reduced Documentary evidence: BP-140/90 mm Hg PR-90/min RR-20/min Self care deficit global (Feeding, toileting, bathing, grooming) related to lack of coordinatio n, muscular weakness Resume s self care activitie s 1. Approach patient from his unaffected side and arrange call light beside table, helps the patient to compensate for alteration in sensory perception. Patient will verbalizes that his self care activities are resumed. Patient is able to perform activities of daily living. ROM, Muscle power, ADL score- increased. 2. Encourage the patient to brush his teeth, comb the hair, bathe and feed himself and to assist in toileting to promote the self care activities. 3. Perform back massage by following 5 steps to prevent the occurrence of bedsore. 4. Help the patient to resume most normal eating position (may sit on chair with pillow support) suited to the patient’s disability to ease the feeding.
- 45. Assessment Nursi ng diagn osis Goal Intervention Evaluatio n Subjective data - Objective data Confusion, Altered gait/mobility diminished cognitive process, Unable to carry out self care activities, Clinical findings Blood pressure- 140/70 mm Hg Visual field deficits Muscle strength score- upper and lower limbs -1/5 Documented evidence Radioimaging studies reveals Consolidation of both the lower lobes of lung field, High risk for injury relate d to altere d senso ry perce ption, dimin ished menta l status, Help the patient to prevent from injury/ falls 1.Place articles within easy reach of the patient to prevent from chance of fall. 2.Orient the patient to surroundings in order to promote familiarity to the situation. 3.Teach the patient about the importance of wearing supportive shoes with good traction when ambulating because it provides better balance and protect from instability on uneven surfaces. 4.Ensure adequate lighting in all areas used by the patient. 5.Use side rails of appropriate height and length which decreases chance of fall from falls. 6.Involve family to aid with activities of daily living and prevent from falls. 7.Avoid use of restraints because they may increase agitation. 8.Provide safe environment which allows the patient to move about as freely as possible and relieves the family of constant worry of safety. 9.Educate the patient about certain medications that may Patient regains normal range of body Temp:99°F Pulse:98ea ts/min Resp:20br eaths/min
- 46. Assessment Nursing diagnosis Goal/ Objective Nursing interventions Evaluation Subjective data: Patient verbalizes on difficulty swallowing a Objective data: presence of NG tube. Clinical findings: Decreased/ absent gag reflex, Documentary evidence: SpO2 90% with 6L of O2. Risk for aspiratio n related to depresse d cough/ gag reflexs, impaired swallowi ng or delayed gastric emptying . Prevent the risk of aspiration 1.Elevate the head of bed at least 30◦ during feedings and for one hour after feeding to prevent reflux by use of reverse gravity. Experien ce no aspiratio n as evidence d by noiseless respirati ons, clear breath sounds; clear, odorless secretion s. 2.Instruct individual and family on activities that increase intra abdominal pressure. Instruct on safety when feeding. 3. Use appropriate measures to check the placement of nasogastric feeding tubes. Malplacement of nasogastric feeding tubes may result in aspiration of enteral formula. 4.Regulate gastric feedings using an intermittent schedule, allowing periods for stomach emptying between feeding intervals. 5. Aspirate the contents every 4th hourly to determine the amount of the residual volume.
- 47. Assessment Nursin g diagno sis Goal Nursing interventions Evaluation Subjective Data The patient verbalizes itching over the site/all over the body. Objective Data Skin-moist colour Skin turgor Clinical findings - Presence of excoriation Dehydration (Stage-) - Chronic bed ridden status (immobility) - Braden’s scale-15/25 - Documented Evidence - Prolonged use of topical applicants Risk for imp aire d skin inte grity relat ed to prol ong ed bed ridde n, patient maintai ns intact, moist and well- lubricat ed skin 1. Inspect the skin frequently for areas of redness, swelling . to detect early signs of infection The patient mainta ins intact and well lubrica ted skin. 2. Provide meticulous skincare to the skin folds that overlap and places where moisture collects. (Abdomen folds, under and between breasts, between buttocks or perineum)to reduce the skin breakdown. 3. Reposition the patient Q2hrly to relieve pressure over bony prominences. 4. Use pressure-reliving devices such as air/water mattress, pillows etc. to promote comfort of the patient. 5.Clip patient’s nails short and keep clean to prevent excoriation 6. Avoid use of perfumed soaps, lotions, deodrants on involved skin surface to prevent skin excoriation. 7. Encourage use of super fatted soap to maintain the moisture content in the skin. 8. Decrease environmental irritants such as heat, scratchy coverings to reduce vasodilatation and sensory stimulation. 9. Encourage adequate fluid intake (2000-3000ml/day) to prevent dehydration. 10. Elevate edematous areas to promote venous drainage.
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