Module2_COPD and Smoking Cessation GRID.pdf

COPD & SMOKING CESSATION COPD Patho Cause Disease Course & Expected Findings Chronic Bronchitis Emphysema **COPD is the name we use for a person with Emphysema & Bronchitis. Most patients with Emphysema have Bronchitis!!! Chronic Inflammation of the bronchi & lung elasticity & hyperinflation of...

COPD & SMOKING CESSATION COPD Patho Cause Disease Course & Expected Findings Chronic Bronchitis Emphysema **COPD is the name we use for a person with Emphysema & Bronchitis. Most patients with Emphysema have Bronchitis!!! Chronic Inflammation of the bronchi & lung elasticity & hyperinflation of the lung bronchioles Cigarette smoking→proteases→break down Cigarette smoke trigger→ # & size of mucous- elastin in alveoli & small airways→some alveoli secreting glands → cilia action of clearing are destroyed and others become large and flabby lungs→large amounts of mucous block small (bullae)→Air trapping in the lungs→flattened & airways and narrow large airways (mucous weak diaphragm→work of breathing→accessory plugs) →  infection risk → PaO2 (hypoxemia) muscle use→demand for oxygen→”Air hunger” PaCO2 (Respiratory acidosis) sensation→Inhalation starts before exhalation completed (uncoordinated breathing) • Smoking! 4th leading cause of M&M in US. NUR3225 Module 2: COPD & Smoking Cessation Updated 8/30/2020 MR 1 COPD Chronic Bronchitis Risk Factors • • • • Emphysema Genetic/environmental problems Smoking! Asthma – 12x the risk for COPD Alpha 1 antitrypsin (AAT) deficiency – an underrecognized problem. AAT is normal in the body. AAT prevents increased levels of proteases. Gene is recessive. Possible scenarios: A. Inherit 1 faulty gene + not smoker = no COPD B. Inherit 1 faulty gene + smoking = high risk of COPD C. Inherit 2 faulty genes + no smoking = COPD at an early age Labs Diagnostics • • • • • • ABG values for abnormal oxygenation, ventilation, acid-base balance Sputum sample to rule out infections CBC – elevated WBCs (infection) H&H – increased RBCs (polycythemia) & iron = compensatory mechanism for hypoxemia Serum electrolytes Serum AAT PFT’s Chest X-ray – hyperinflation & FLATTENED diaphragm NUR3225 Module 2: COPD & Smoking Cessation Updated 8/30/2020 MR 2 COPD Chronic Bronchitis Meds Same as asthma • Beta-adrenergic agents • Cholinergic antagonists • Methylxanthines • Corticosteroids • NSAIDs • Mucolytics Lung transplant surgery – rare Lung reduction surgery 1. Hypoxemia/Acidosis a. Smoking cessation encouraged! Patient Smoking Cessation Education Sheet – TESTABLE MATERIAL – CLICK HERE TO REVIEW Procedures Complicatio ns & Nursing Care NUR3225 Module 2: COPD & Smoking Cessation Updated 8/30/2020 MR Emphysema 3 COPD Chronic Bronchitis Emphysema b. Breathing techniques – IS? NUR3225 Module 2: COPD & Smoking Cessation Updated 8/30/2020 MR 4 COPD Chronic Bronchitis Emphysema a. Positioning/Exercise Conditioning – SOB when lying (Orthopnea). Upright. Up in chair 3x daily for at least an hour. Fatigue is a major issue! Assess for issues with activity intolerance – how long does it take you to perform your morning routine? Do you walk upstairs every day? Have you lost any weight today? →Pulmonary rehab, energy conservation. Don’t walk with arms raised. Pace activities. (occupational therapist) b. Effective coughing – often have productive cough in the morning. Encourage cough before meals/bedtime. i. Sit in a chair or on the side of a bed with feet on the floor. ii. Turn the shoulders in and head slightly down, hugging a pillow against the stomach. iii. Take a few breaths, trying to exhale more fully. iv. After 3rd or 4th, take a deeper breath and bend forward slowly while coughing 23x (“mini” coughs) from the same breath. v. On return to a sitting position, take a final deep breath. vi. Repeat at least twice. NUR3225 Module 2: COPD & Smoking Cessation Updated 8/30/2020 MR 5 COPD Chronic Bronchitis Emphysema c. Oxygen therapy i. NC – 2-4L or 40% venturi mask. Humidified may be needed. ii. In the past, the patient with COPD was thought to be at risk for extreme hypoventilation with oxygen therapy because of a decreased drive to breathe as blood oxygen levels rose. However, this concern has not been shown to be evidence based and has been responsible for ineffective management of hypoxia in patients with COPD. All hypoxic patients, even those with COPD and hypercarbia, should receive oxygen therapy at rates appropriate to reduce hypoxia and bring SpO2 levels up between 88% and 92% (Burt & Corbridge, 2013; Makic et al., 2013) d. Drug therapy - Teach the patient to self-monitor the peak expiratory flow rates at home and adjust drugs as needed i. Manage anxiety with SOB! e. Suctioning – only if needed f. Hydration/Nutrition – Watch weight & physical appearance (tripod position, enlarged neck muscles i. Diet – 2L per day. High protein, high calorie diet – prevent weight loss from increased work of breathing. Pulmocare supplements may be needed. No dry/gas forming foods NUR3225 Module 2: COPD & Smoking Cessation Updated 8/30/2020 MR 6 COPD Chronic Bronchitis Emphysema 2. Respiratory Infection/failure→Hospitalizations! 3. Cardiac failure/dysrhythmias Goals – The patient with COPD is expected to attain and maintain GAS EXCHANGE at his or her usual baseline level. Indicators include that the patient: • Maintains SpO2 of at least 88% • Remains free from cyanosis • Maintains cognitive orientation • Coughs and clears secretions effectively • Maintains a respiratory rate and rhythm appropriate to his or her activity level NUR3225 Module 2: COPD & Smoking Cessation Updated 8/30/2020 MR 7