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83 terms

Chronic Obstructive Pulmonary Disease (COPD)

BCCC 102 med surg
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Chronic Obstructive Pulmonary Disease (COPD)
disease state characterized by the presence of airflow obstruction caused by chronic bronchitis or emphysema
Primary cause of COPD
Cigarette smoking
Effects of Cigarette Smoking
irritating effects on the respiratory tract
reduces ciliary activity and can cause loss of ciliated cells
produces abnormal dilation of distal air spaces w/ destruction of alveolar walls
Most common causative organisms (infection)
Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis
Causes
Cigarette smoking
Ambient Air Pollution
Heredity <1% of cases in U.S
Aging
Aging
lung structure (become more rounded and smaller)
thoracic cage (becomes stiff and rigid)
respiratory muscles and the number of functional alveoli decreases
gradual loss of elastic recoil in lungs
Emphysema
abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls
Emphysema Structural Changes
hyperinflation of alveoli, destruction of alveolar walls and capillary walls, narrowed and small airways, and loss of lung elasticity
2 major types of emphysema
Centrilobular and Panlobular
Centrilobular
the primary area of involvement is the central part of the lobule. Chronic bronchitis is often associated with this kind
Panlobular
(less common) involves distention and destruction of the whole lobule
Clinical Manifestations of Emphysema
Dyspnea which becomes progressively worse and more severe
DOE (dyspnea on exertion) progresses to interfering w/ ADLs (activities of daily living) to dyspnea at rest
Minimal coughing w/ NO sputum
Flattened diaphragm and barrel chest
Physical Manifstations of Emphysema
Thin and underweight even with adequate calorie intake (may be do to hypermetabolism or increased work of breathing)
Loss of lean muscle mass and subcutaneous fat
Advanced stages shows finger clubbing
Chronic Bronchitis
Excessive production of mucus in the bronchi accompanied by a recurrent cough that lasts for at least 3 months of the year during at least 2 successive years
Chronic Bronchitis Pathological changes
hyperplasia of mucous secreting glands in the trachea and bronchi, increase in goblet cells, disappearance of cilia, chronic inflammatory changes and narrowing of small airway, altered function of alveolar macrophages leading to increased bronchial infections (frequently airways are colonized w/ microorganisms
Clinical Manifestations of Chronic Bronchitis
frequent productive cough mostly during winter months and exacerbated by respiratory irritants and cold, damp air
Frequent respiratory infections
DOE (dyspnea on exertion)
H/O (history of) cigarette smoking
Hypoxemia and hypercapnia from hypoventilation caused by increased airway resistance
Hemoglobin 20 g/dl or >
Physical Manifstations of Chronic Bronchitis
Bluish-red color of the skin from polycythemia (increased RDC production as body tries to compensate) and cyanosis
Usually normal weight or heavyset
Cor Pulmonale
hypertrophy of the right side of the heart with or w/o heart failure resulting from pulmonary hypertension (caused by constriction of the pulmonary vessels in response to alveolar hypoxia)
pulmonary hypertension
pressure on the right side of the heart must increase to push blood into the lungs (eventually right sided heart failure develops)
Cor Pulmonale S/S
ECG (elecrocardiogram) changes, neck vein distention, hepatomegaly (enlarged liver) w. right upper quadrant tenderness, ascites (fliud in the peritoneal cavity), epigastric distress, peripheral edema and weight gain
Cor Pulmonale Management
low-flow O2 therapy, salt restriction, and diuretics
Acute Exacerbations of Chronic Bronchitis
acute infection - mucous which is stagnant and breeds microorganisms
worsened cough, hemoptysis (coughing up of blood), wheezing, increased SOB, changes in amount, color, consistency, or viscosity of sputum
Chronic Bronchitis Treatment
antibiotics, increase of bronchodialtor usage, corticosteroids, humidification, postural drainage
Acute Respiratory Failure
Usually an acute resp. infection or acute bronchitis leads to this
Hypercapnia
increased (CO2) in the blood
COPD O2 treatment
low flow rates of O2 and careful monitoring of ABGs (Arterial Blood Gas)
PUD (Peptic Ulcer Disease)
increased in the person w/ COPD but the reason is unknown
GERD (Gastro-esophageal Reflux Disease)
frequently in COPD patients and may aggravate respiratory symptoms (may be precipitated by COPD meds)
Pneumonia
Frequent complication of COPD
Most common causative agents are; S. pneumoniae, H. influenzae and viruses
Common manifestation is purulent sputum, maybe fever and chills
Respiratory Acidosis
retained CO2 results in accumulation of carbonic acid in the blood causing a decrease in pH
Bicarbonate HCO3 (normal)
22‐26 mEq
pH (normal)
7.35 - 7.45
PaCO2 (normal)
35-45 mm Hg
Respiratory Acidosis Uncompensated
pH low - PCO2 high - HCO3ok
Respiratory Acidosis Partial compensation
pH low - PCO2 high - HCO3 high
Respiratory Acidosis Compansated
pH ok - PCO2 high - HCO3 high
R O M E
respiratory opposite, metabolic equal
Who's the boss?
pH
PCO2
represents acid
HCO3
represents alkaline
Respiratory Alkalosis Uncompensated
pH high - PCO2 low - HCO3 ok
Respiratory Alkalosis Partial compensation
pH high - PCO2 low - HCO3 low
Respiratory Alkalosis Compansated
pH ok - PCO2 low - HCO3 low
Metabolic Acidosis Uncompensated
pH low - PCO2 ok - HCO3 low
Metabolic Acidosis Partial compensation
pH low - PCO2 low - HCO3 low
Metabolic Acidosis Compansated
pH ok - PCO2 low - HCO3 low
Metabolic Alkalosis Uncompensated
pH high - PCO2 ok - HCO3 high
Metabolic Alkalosis Partial compensation
pH high - PCO2 high - HCO3 low
Metabolic Alkalosis Compansated
pH ok - PCO2 high - HCO3 high
Diagnostic Studies for COPD
Health history and physical examination
Chest x-ray
Pulmonary function tests
Sputum specimen and culture
ABG
ECG
Exercise testing w/ oximetry
Echocardiogram or cardiac nuclear scan if needed
COPD Therapy
Breathing exercises and retraining
Hydration (3L/day)
Smoking cessation
Appropriate rest periods
Education
Flu vaccine
Low flow O2
Pulmonary rehab
Chest PT
COPD medications
Bronchodilator therapy: B-Adrenergic Agonist drugs (Proventil, Ventolin), Anticholenergic agents (Atrovent), Theophylline
Corticosteriods
Beta blockers treat
a variety of conditions, such as high blood pressure, glaucoma and migraines (ex. Tenormin, Coreg, Lopressor)
?Why not use beta blockers for COPD patients?
They reduce heart rate; reduce blood pressure by dilating blood vessels; and may constrict air passages by stimulating the muscles that surround the air passages to contract (possibility of worsening respiratory function from the potential side effect of bronchoconstriction)
Oxygen Delivery Systems Two categories
High flow O2 systems and Low flow O2 systems
low flow system
the % of oxygen delivered is determined by the person's rate, volume and pattern
high flow system
provides a flow rate and reservoir capacity to meet total inspired air needs
COPD O2 rate
provide the lowest % O2 that will maintain arterial O2 saturation within normal range
Low-flow Systems Include
nasal cannula, oxygen mask, or oxygen mask with reservoir
nasal cannula
most comfortable and most commonly used (it doesn't interfere w/ talking, eating, and can even be used w/ a mouth breather)
simple face mask
shaped to fit snugly over the nose and mouth. The sides have holes so exhaled CO2 can escape and O2 is mixed w/ room air. This is used when client needs a higher FIO2 (frational concentration of inspired oxygen) than provided by nasal cannula
non-rebreather mask
highest FIO2 (frational concentration of inspired oxygen). The bag fills w/ 100% O2. The air holes have a 1 way valve to allow exhaled air to escape and does not allow room air to enter
Do not let the bag get deflated or else the client will suffocate
Partial rebreathing mask
> in FIO2 (frational concentration of inspired oxygen) than the simple face mask but < in FIO2 than non-rebreather. Limited usefulness
Venturi device
beneficial in treating a client with chronic respiratory disease. Small amounts of O2 can be delivered very precisely (High-flow System)
Humidification of O2
prevent irritation and drying of the airways
Bubble diffusion humidifiers
Used w/ O2 (O2 is bubbled through H2O)
Use if O2 is needed more than 24 hours
Complications of Oxygen Use
Combustion, Carbon Dioxide Narcosis, Oxygen Toxicity
Combustion
No smoking unless you want to blow up. Signs should be placed around patient use area
Carbon Dioxide Narcosis
Sometimes increasing the rate of O2 can cause respiratory distress
Oxygen Toxicity
Monitor ABGs to avoid this. It can result from prolonged exposure to O2
Severe Hyperoxia
caused by breathing oxygen at elevated partial pressures. The high concentration of oxygen damages cells.
Pursed-lip breathing
The purpose is to prolong exhalation and prevent bronchiolar collapse and air trapping
Diaphragmatic breathing
focuses on using the diaphragm instead of the accessory muscles to achieve maximum inhalation and slow the respiratory rate
Chest Physiotherapy Includes
percussion, vibration, and postural drainage
Percussion
Use a cup-like position of the hands, fingers and thumbs are closed. Whack the patient and a hollow sound should be heard
Vibration - can be manual or machine. This again facilitates secretions upwards to be cleared
can be manual or machine. Facilitates secretions upwards to be cleared
Postural drainage
Positions which facilitate the upward movement of secretions. Sometimes bronchodilators are used prior
Ambulate
this increases rate and depth of breathing, opens the alveoli and distributes airflow through the lungs
Incentive Spirometry
a device that provides a visual goal encouraging the client to execute and sustain maximal inspiration. Opens airways, reduces actelectasis, stimulates coughing. Have client breath in deeply, hold for 3 seconds then exhale. Used frequently post-op
Pulmonary Rehabilitation
include; PT, nutrition and education
Activity considerations
energy conservation by spacing activities and allowing sufficient rest periods (modify sex routine, get adequate sleep)
Tracheostomy
A surgically created opening into trachea to establish an airway
Tracheostomy reasons for
To bypass an upper airway obstruction
Facilitate removal of secretions
Permit long-term mechanical ventilation
Permit oral intake and speech in a pt who requires mechanical ventilation