COPD PowerPoint Presentation PDF

Chronic obstructive pulmonary disease Dr:Neama Mamdouh Mostafa Definition:  It is a disease state characterized by airflow limitation that is not fully reversible. COPD may include diseases that cause airflow obstruction (eg, emphysema, chronic bronchitis) or...

Chronic obstructive pulmonary disease Dr:Neama Mamdouh Mostafa Definition:  It is a disease state characterized by airflow limitation that is not fully reversible. COPD may include diseases that cause airflow obstruction (eg, emphysema, chronic bronchitis) or a combination of these disorders  Emphysema develops when there is damage to the walls between air sacs in the lungs. In emphysema, it is harder for lungs to move air out of body.  Chronic bronchitis is caused by repeated or constant irritation and inflammation in the lining of the airways. Lots of thick mucus forms in the airways, making it hard to breathe Chronic Bronchitis  It is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. In many cases, smoke or other environmental pollutants irritate the airways, resulting in hypersecretion of mucus and inflammation.  The bronchial walls become thickened, the bronchial lumen is narrowed, and mucus may plug the airway. Emphysema Abnormal distention of the air spaces beyond the terminal bronchioles, with destruction of the walls of the alveoli. Risk Factors for COPD:  Environmental Factors:  Cigarette smoking in addition, passive smoking  prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution,  A host risk factor  A deficiency of alpha1 antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. Clinical Manifestations COPD  Three primary symptoms: cough, sputum production, and dyspnea on exertion.  Cough with mucus for a long time (for three months or longer at a time for at least two years).  Shortness of breath, especially when performing daily activities or with mild exertion.  Wheezing.  Barrel-shaped chest.  Bluish skin (cyanosis). Weight loss  Chronic hyperinflation leads to the “barrel chest”. Assessment and Diagnostic Findings:  Pulmonary function studies (Spirometry) is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 (forced expiratory volume in 1 second (FEV1) is the maximum air the subject can forcibly expel during the first second following maximal inhalation.) to FVC (forced vital capacity). is the amount of air that can be forcibly exhaled from your lungs after taking the deepest breath possible. Obstructive lung disease is defined as a FEV1/FVC ratio of less than 70%.  Arterialblood gas  Chest x-ray.  Genetic: Alpha1 antitrypsin deficiency screening for patients under age 45 or for strong family history of COPD Complications:  Respiratory failure.  Pulmonary hypertension.  Cor pulmonale.  Pneumothorax.  Atelectasis  Corpulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the pulmonary arteries of the lung and right ventricle of the heart can lead to cor pulmonale. Stages of COPD: based on (FEV1) results.  Stage 1: FEV1 is 80 or above.  Stage 2: FEV1 is between 50 and 79.  Stage 3: FEV1 is between 30 and 49.  Stage 4: FEV1 is less than 30 Medical Management:  Smoking cessation programs.  Pharmacological therapy:  Bronchodilators and steroids can reduce inflammation and open airways (as an inhaler or as a liquid put in a nebulizer).  Antibiotics.  Other Medications: yearly influenza vaccine and the pneumococcal vaccine every 5 to 7 years as preventive measures.  Oxygen therapy  Pulmonary rehabilitation. This is an exercise and education program that can strengthen lungs  Positive airway pressure. Using a BiPAP /BPAP machine (noninvasive ventilator) especially during an exacerbation. Positive airway pressure (PAP) treatment uses a machine to pump air under pressure into the airway of the lungs. This helps keep the windpipe open during sleep. The forced air delivered by CPAP (continuous positive airway pressure) prevents episodes of airway collapse that block the breathing in people with obstructive sleep apnea and other breathing problems.  Surgical management  Bullectomy: surgical removal of bullae (enlarged airspaces). which is a dilated air space in the lung parenchyma measuring more than 1 cm.  Lung Volume Reduction Surgery: removal of a portion of the lung parenchyma for end- stage COPD (stage III)  Lung Transplantation. for end-stage emphysema. Signs and symptoms of exacerbation  Increased dyspnea,  Increased sputum production and purulence,  Respiratory failure,  Changes in mental status  Worsening blood gas abnormalities Management of exacerbation  The primary cause of the exacerbation is identified  Optimization of bronchodilator medications  Corticosteroids, antibiotic agents, oxygen therapy  Intensive respiratory interventions may also be used. Nursing Management:  Breathing Exercises.  Inspiratory Muscle Training: The patient breathes against resistance for 10 to 15 minutes every day.  Self-Care Activities: diaphragmatic breathing with activities such as walking, bathing, bending, or climbing stairs.  Physical Conditioning: encourage using treadmills, stationary bicycles, and walks to improve symptoms and increase work capacity and exercise tolerance.  Oxygen Therapy. the nurse explains the proper flow rate and required number of hours for oxygen use. cautions that smoking with or near oxygen is extremely dangerous.  Nutritional Therapy: Assessment of caloric needs and counseling about meal planning and supplementation Nursing process:  Assessment: involves obtaining information about current symptoms as well as previous disease manifestations.  Nursing Diagnosis  Impaired gas exchange and airway clearance due to chronic inhalation of toxins  Impaired gas exchange related to ventilation– perfusion inequality  Ineffective airway clearance related to bronchoconstriction, increased mucus production, ineffective cough, bronchopulmonary infection, and other complications  Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction, and airway irritants  Activity intolerance due to fatigue, ineffective breathing patterns, and hypoxemia  Deficient knowledge of self-care strategies to be performed at home.  Ineffective coping related to reduced socialization, anxiety, depression, lower activity level, and the inability to work Nursing Interventions  Promoting smoking cessation:  The nurse should educate the patient regarding the hazards of smoking and cessation strategies, counseling, and formalized programs available in the community.  Improving gas exchange:  Monitor the patient for dyspnea and hypoxemia.  Administer the medications properly and be alert for potential side effects.  Achieving airway clearance  Diminishing the quantity and viscosity of sputum can clear the airway and improve pulmonary ventilation and gas exchange.  Eliminate pulmonary irritants, particularly cigarette smoking,  The nurse instructs the patient coughing exercises, Chest physiotherapy with postural drainage,  Intermittent positive-pressure breathing,  Increased fluid intake, and bland aerosol mists (with normal saline solution or water).  Improving breathing pattern  Inspiratory muscle training and breathing retraining help to improve breathing patterns.  Training in diaphragmatic breathing reduces the respiratory rate, increases alveolar ventilation.  Pursed-lip breathing helps to slow expiration, prevents collapse of small airways, and helps the patient to control the rate and depth of respiration.  Encourage relaxation, to control dyspnea and reduce feelings of panic.  Improving Activity intolerance.  Education is focused on rehabilitative therapies to promote independence in executing activities of daily living which include:  Pacing activities throughout the day  Using supportive devices to decrease energy.  Exercise training to strengthen the muscles of the upper and lower extremities and improve exercise tolerance and endurance.  Enhancing self-care strategies by:  Setting Realistic Goals  Avoiding Temperature Extremes. Heat increases the body temperature, raising oxygen requirements; cold tends to promote bronchospasm. Air pollutants such as fumes, smoke, dust, and even talcum, lint, and aerosol sprays may initiate bronchospasm.  Modifying Lifestyle Patients  avoid emotional disturbances and stressful situations that might trigger a coughing episode.