Chronic obstructive pulmonary disease(COPD)

Dr. Walaa NasrLecturer of Adult Nursing Second year

COPDOut linesWhat is the COPD?OverviewCauses of COPDSymptoms of COPDWhat's the difference between COPD and asthma?Diagnostic tests needed for COPDMedical management of COPDPreventive measuresNursing interventionOutlook and Prognosis

COPD Definition COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

COPD Overview

COPD OverviewIn 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.

COPD CausesSmokingAir pollutiongenetic (hereditary) risk

COPD SymptomsProductive coughBreathlessnessChest infectionOther symptoms of COPD can be more vague, weight loss, tiredness and ankle swelling.

Difference between COPD and AsthmaIn 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 testsSymptomsPhysical examinationSample of sputum Chest x-rayHigh-resolution CT (HRCT scan)Pulmonary function test (spirometery) Arterial blood gases testPulse oximeter

COPD Medical managementGive 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)Stop smoking

Oxygenation with low concentration during the acute episodes

In asthma adrenaline ( epinephrine) SC if the bronchospasm not relieved.

Aminophylins IV if the above treatment does not help.

IV corticosteroids for patients with chronic asthma or frequent attack.

Sedative or tranquilizers to calm the patient.

Increase fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation.

Intubations and mechanical ventilation if there is respiratory failure.

COPDPreventive measuresTo 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

COPDPreventive 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.

COPDPreventive 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 hours.

COPDNursing interventionAssessment History Patient's environmentWork history, exercise pattern, smoking habitsThe onset & development of symptomsSleeping positions

COPDNursing intervention (cont)Physical examinationSigns of heavy smokersObserve for clubbingDistended neck vein on expirationThe presence of barrel chestObserve for abdominal breathingThe use of pursed lips breathing and chest movementAuscultate the chest& listen for musical wheezes characteristics of chronic bronchitis

COPDNursing intervention (cont)review the results of diagnostic procedure:Arterial blood gasesPulmonary function tests X-ray filmsNursing diagnosisIneffective 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

COPDNursing 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