Chronic Obstructive Pulmonary Disease Overview

Chronic Obstructive Pulmonary Disease (COPD)

• Affects 15 million in the U.S. and 900,000 in Canada.
• 4th leading cause of morbidity and mortality in the U.S.
• Defined as a collection of lower airway disorders hindering airflow and gas exchange.
• Includes two main conditions:
  • Emphysema: Destruction of lung elastic tissue reduces recoil capability, causing hyperinflation and air trapping.
  • Chronic Bronchitis: Inflammation of bronchi/bronchioles due to irritants like cigarette smoke, leading to mucus overproduction and airway obstruction.

Pathophysiology of COPD

• Alveolar damage results in gas exchange compromise; leads to CO2 retention and respiratory acidosis.
• Patients experience increased work of breathing and sensations of "air hunger."

Risk Factors for COPD

• Cigarette smoking is the primary risk factor.
• Additional risk factors include alpha1-antitrypsin deficiency and prior asthma.

Complications of COPD

• Potential complications include:
  • Hypoxemia
  • Respiratory acidosis
  • Respiratory infections
  • Cardiac failure (cor pulmonale)
  • Dysrhythmias
  • Respiratory failure

COPD Assessment and Management

• Importance of thorough medical history and physical assessment:
  • Includes smoking history, breathing issues, activity levels, and weight gain.
• Laboratory assessments focus on ABGs and pulse oximetry to monitor oxygen saturation (target: 88-92%).

Weight Management and Anxiety in COPD Patients

• Strategies to prevent weight loss include frequent small meals and high-calorie food options.
• Anxiety management techniques, such as counseling, hypnosis, and relaxation techniques, are essential.

Prevention and Recovery

• Prioritize smoking cessation and manage infections, including pneumonia.
• Focus on improving endurance to assist with activities of daily living.

Overview of Asthma

• Can occur at any age, with a peak incidence between 10-17 years.
• 8.3% of U.S. children are affected, with higher rates in urban areas and African American populations.

Asthma Pathophysiology

• Characterized by reversible obstructive airway disease due to inflammation, bronchospasm, and mucus accumulation.
• Assess for related conditions like allergic rhinitis and sinusitis.

Asthma Symptom Assessment

• Key indicators of asthma control:
  • Frequency of daytime symptoms (wheezing, dyspnea, coughing).
  • Nighttime symptoms and reliance on rescue medications.
  • Activity limitation due to asthma symptoms.

Asthma Therapy Goals

• Objectives focus on improving airflow and gas exchange through recognition of symptoms, avoidance of triggers, proper medication administration, and patient education.

Asthma Medications

• Rescue medications include inhaled short-acting beta agonists (e.g., Albuterol) and anticholinergics.
• Control medications (long-term) include inhaled corticosteroids, long-acting beta agonists, and leukotriene inhibitors.

Emergency Asthma Treatment Indicators

• Signs indicating the need for urgent care include worsening symptoms unresponsive to bronchodilators, trouble breathing, or signs of cyanosis (blue lips or nails).

Status Asthmaticus

• A life-threatening severe asthma episode that can lead to pneumothorax and respiratory/cardiac arrest; requires emergency treatment.

Environmental Modifications for Asthma Patients

• Implement strategies to minimize allergens, such as using dust-proof covers, cleaning regularly, and maintaining proper household humidity levels.

Chronic Obstructive Pulmonary Disease (COPD) Overview

• Affects approximately 15 million in the U.S. and 900,000 in Canada.
• 4th leading cause of morbidity and mortality in the U.S.
• Defined as a collection of lower airway disorders that interfere with airflow and gas exchange.

Emphysema

• Characterized by destruction of lung elastic tissue, reducing recoil ability and causing hyperinflation.
• Results in air trapping, increased work of breathing, sensation of "air hunger," and decreased gas exchange leading to CO2 retention and respiratory acidosis.

Chronic Bronchitis

• Inflammation of bronchi and bronchioles primarily caused by irritants like cigarette smoke.
• Triggers inflammation, vasodilation, congestion, and bronchospasm.
• Thickened bronchial walls and excessive mucus impede airflow, increasing infection risks.

Risk Factors

• Primary risk factor: Cigarette smoking.
• Other factors include alpha1-antitrypsin deficiency and asthma.

Complications of COPD

• Hypoxemia and acidosis.
• Respiratory infections.
• Cardiac failure, specifically cor pulmonale.
• Dysrhythmias and respiratory failure.

Assessment Techniques

• Physical assessment includes recognition of respiratory and cardiac changes.
• Psychosocial assessments focus on the individual’s emotional well-being.
• Laboratory assessments such as arterial blood gases (ABG’s) aid in monitoring hypoxemia and hypercapnia.

COPD Management Strategies

• Oxygen administration requires careful monitoring, aiming for O2 saturation of 88-92%.
• Weight management through small, high-calorie meals and strategies to reduce dyspnea during eating, such as pursed-lip breathing.
• Support for anxiety through counseling, relaxation techniques, and developing a clear management plan.

Health Promotion and Maintenance

• Smoking cessation is vital for prevention of further disease progression.
• Home care management and self-management education regarding drug therapies and breathing techniques are essential.
• Goals include maintaining baseline gas exchange, achieving effective breathing patterns, and avoiding respiratory infections.

Evaluation of Outcomes

• Assess progress toward maintaining a body weight within 10% of ideal weight and increased acceptable activity levels.
• Reduction in anxiety levels and implementation of strategies to prevent serious respiratory infections.

NCLEX Style Questions

• Examples provided assess understanding of patient statements that indicate worsening dyspnea, proper chest tube care, and priority actions based on peak flowmeter readings.

Conclusion

• Management of COPD requires a multi-faceted approach involving risk assessment, careful monitoring, lifestyle modifications, and coordination of care to improve patient outcomes.