Chronic Obstructive Pulmonary Disease (COPD) PDF

LECTURE | PRELIM NCM 118 Medical-Surgical Nursing (Care of Clients with Life-Threatening Conditions, Acutely Ill Multi Organ Problems, High Acuity and Emergency Situation) M EDICAL-SURGICAL NURSING ALT ERED VENT ILATORY FUNCT IONS CHRONIC OBSTRUCTIVE PULMONARY DISEA...

LECTURE | PRELIM NCM 118 Medical-Surgical Nursing (Care of Clients with Life-Threatening Conditions, Acutely Ill Multi Organ Problems, High Acuity and Emergency Situation) M EDICAL-SURGICAL NURSING ALT ERED VENT ILATORY FUNCT IONS CHRONIC OBSTRUCTIVE PULMONARY DISEASE DIAGNOSTIC TEST  It is a condition of chronic dyspnea with expiratory airflow limitation → History Taking that does not significantly fluctuate. → Physical Exam  A preventable & treatable slowly progressive respiratory disease of → CXR airflow obstruction involving the airways, pulmonary parenchyma, or → ABG both → PFT: Spirometry  Group of chronic & progressive inflammatory lung disease → A1 Antitrypsin Levels  IRREVERSIBLE → CT Scan - differential diagnosis  Combination of emphysema and chronic bronchitis. → 6-minute walk test 1. Emphysema o Normal: Without Exertion  Damage and rupture of inner structure of alveoli o COPD: Catch Breathing 2. Chronic bronchitis  Inflamed lining of the Bronchus SIGN & SYMPTOMS CHRONIC BRONCHITIS Chronic bronchitis  Smoker’s cough  BLUE BLOATERS: bloated because of CO2 is trap Peripheral edema  Defined by CLINICAL FEATURES Rhonchi and wheezing  Overweight = Right Sided Heart Failure Emphysema  Inflammation and fibrosis Quiet chess Older and thin PATHOPHYSIOLOGY Smoking CAUSES irritation of the respiratory tract Respiratory Virus goblet cells & mucus-secreting glands are activated to ↑ mucus → Influenza virus, Rhinovirus inflammation Airway Bacteria ↑mucus production Hyperplasia & hypertrophy Bronchoconstriction → Bordatella PRODUCTIVE COUGH of submucosal glands DOB → Haemophilus Influenzae (Most common) Fibrosis uses of accessory muscle Alpha 1 Anti- Trypsin Deficiency FATIGUE → Protect the lungs from infection anorexia= WT. LOSS → Protein made from liver Air Trapping HYPERINFLATION RISK FACTORS SMOKING – destroys cilia Genetics (Alpha-1 antitrypsin deficiency) SIGN & SYMPTOMS Frequent respiratory Infection as child  FIRST SIGN: Productive cough for 3 months in 2 consecutive years Age over 65 yrs. Old  Wheezing (due to narrow airway) Asthma  Crackles (rales) popping sound (open of the small airway) Frequent exposure to chemicals/ pollution  Hypoxemia & hypercapnia ASSESSMENT  Cyanosis - Increase PCO2, decrease PO2  Peripheral edema History Taking  Obesity Physical Examination Inspection Palpation: Barrel Chest / Hyperinflated Percussion o Hyperresonance on the infected side Auscultation o Wheezing (musical sound) o Crackles – popping sound (alveoli are force to open) Faith Depasupil BSN 4-D (2024-2025) 1  LECTURE | PRELIM NCM 118 Medical-Surgical Nursing (Care of Clients with Life-Threatening Conditions, Acutely Ill Multi Organ Problems, High Acuity and Emergency Situation) EMPHYSEMA CLINICAL MANEFESTATION  Sefined as an abnormal permanent enlargement of air spaces distal to  Chronic Cough – primary symptoms the terminal bronchioles, accompanied by the destruction of alveolar  Sputum production walls and without obvious fibrosis.  Dyspnea upon exertion  Hyperinflated/ over distention of the alveoli  Dyspnea at rest  Defined by STRUCTURAL CHANGES  Weight loss= dyspnea interferes with eating  Acinar cells are destroyed  Barrel Chest  Structural tissue destruction secondary to inflammation and fibrosis PREVENTION PATHOPHYSIOLOGY Smoking cessation - most cost-effective intervention to reduce risk of Smoking → irritation → inflammation → Stimulates neutrophils → elevate elastase activity developing COPD (breakdown the elastin; A1AT is destroying elastase) Destruction of Elastic Fibers Destruction of alveolar septa ↑ Fibrosis TREATMENT Loss of elastic recoil of lungs Reduced surface area for gas exchange No cure! Focused on symptom management Expiratory narrowing of small airways Bronchial Collapse Airway Obstruction Bronchial collapse PHARMACOLOGIC THERAPY Air trapping Enlarged air sacs  Bronchodilators (Salbuterol & Albuterol) - Relieve bronchospasm Hyperinflation  Corticosteroids (Prednisone) - Short trial course of oral corticosteroid)  Anticholinergics (decrease exacerbation) SIGN & SYMPTOMS  Antibiotic  Mucolytic  FRIST SIGN: SOB & Fatigue  Vasodilators  Barrel Chest  Narcotics  ↑ AP Diameter  ↓ Breath sounds  Pink Skin (Hyper oxygenated)  Pulmonary Rehab – Most effective  Pursed Lip (mechanism to avoid rupturing of alveoli)  Breathing Techniques  Tachypnea & dyspnea  Exercise (Walking & upper limb exercise)  Cachexia = muscle wasting  Nutrition  Pt is in Tripod px  Educate the importance of sleep and good nutrition  Minimal cough  Hydration – if indicated  Long term 02 – indicated The hallmark physical examination finding of emphysema is the limitation of expiratory flow with relative preservation of inspiratory flow. A forced expiratory time more than 6 seconds indicates severe expiratory airflow obstruction. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) are used in determining flows. The ratio of the two (FEV1/FVC) results as a percentage on spirometry and is used to SURGICAL MANAGEMENT confirm the diagnosis of obstructive airway disease and assess responses to treatment and disease progression.  Lung Volume Reduction TYPES OF EMPHYSEMA Palliative surgery 1. CENTRIACINAR/ CENTRILOBULAR Remove the affected area of the lungs  Upper lungs  CAUSE: Smoking  Bullectomy  Affect the upper lobes For bullous emphysema 2. PANACINAR Removal of the alveoli  All part of acinus  CAUSE: 1At deficiency  Lung Transplant  Affect lower lobes of lungs Definitive surgical treatment for end-stage emphysema 3. PARASEPTAL  Distal acinar COMPLICATION OF COPD  Affects entire lung tissue in periphery of lobule Respiratory Failure  Rapture can cause PNEUMOTHORAX= Place pt in orthopneic position.  The acuity and the onset of respiratory failure depends on the baseline function, pulse oximeter or ABG values  (Hypercapnia & hypoxemia = ↑RR & ↑WOB) Cor Pulmonale Prolonged hypoxemia cause vasoconstriction→ PVR↑ →Pulmo HPN → Right Ventricle Hypertrophy → RHF Tx: Diuretics & mgt of underlying causes Pulmonary Hypertension Faith Depasupil BSN 4-D (2024-2025) 2  LECTURE | PRELIM NCM 118 Medical-Surgical Nursing (Care of Clients with Life-Threatening Conditions, Acutely Ill Multi Organ Problems, High Acuity and Emergency Situation) Treatment: diuretics, vasodilators, anticoagulants, Ca Channel Blocker o Diaphragmatic breathing o Pursed lip breathing Respiratory Insufficiency To improve activity intolerance Acute or chronic, and may need ventilator support until other acute o Manage daily activities complications can be treated o Exercise training o Walking aids Pulmonary Insufficiency To monitor and manage potential complications Due to backflow o Monitor cognitive changes o Monitor pulse oximetry values o Prevent infection Acute Exacerbation Tx: ABG, fowler’s position, suction as needed EVALUATION Identifies hazard of cigarette smoking MANAGEMENT Identifies resources for smoking cessation 1. Bronchodilator - first - line therapy Free of infection 2. Close monitoring Practices breathing techniques o O2 sat: 88 – 92% Perform activities with less SOB o ABG o Lung Sound o Secretions 3. Give O2 with caution DISCHARGE AND HOME CARE GUIDE 4. At risk for hypercapnia Setting goals 5. O2 is given in low flow Temperature Controls 6. Hospitalization – severe dyspnea that does not respond to initial Activity moderation therapy, confusion, lethargy Breathing Retraining 7. Diet: High Calorie: High Protein DOCUMENTATION NURSING MANAGEMENT Document the assessment findings Health education o RR Improve respiratory status o Character of breath sounds o Sputum Plan of care and specific interventions NURSING ASSESSMENT Document teaching plan Medical Hx Modifications of plan of care VS (for baseline) Attainment of progress towards goals Breath sounds GOAL Improve gas exchange Improve Breathing Pattern Achieve airway clearance Independence in self – care activities NURSING PRIORITIES Maintain patent airway Breathing (gas exchange) Enhance nutritional Intake Prevent complications Provide info about disease NURSING INTERVENTIONS To achieve airway clearance: Bronchodilators and corticosteroids To improve breathing pattern: o Inspiratory muscle training Faith Depasupil BSN 4-D (2024-2025) 3  LECTURE | PRELIM NCM 118 Medical-Surgical Nursing (Care of Clients with Life-Threatening Conditions, Acutely Ill Multi Organ Problems, High Acuity and Emergency Situation) ACUTE RESPIRATORY DISTRESS SYNDROME INDIRECT INJURY  A life – threatening lung condition. It is a form of breathing failure that o Sepsis can occur in very ill or severely injured people o Pancreatitis (Systemic inflammation)  It is a pulmonary edema that results to ARF o Massive Blood Transfusion  Not a primary lung disease/ not a specific disease o Pneumonia  A COMPLICATION from a systemic injury that cause widespread o Lung & Bone marrow transplantation inflammation damaging alveoli o Within few days of lung transplantation (Rejection)  Alveolar capillary membrane – is the main site of injury o Drug overdose  Patient is confused and has a decreased BP *Something that is spreading in the bloodstreams or systemic that  High mortality rate diffuses out.  ABG levels identify respiratory acidosis  X-ray shows bilateral infiltrates  Interstitial edema might not be noted until there is 30% increase in RISK FACTORS fluid content Develops in people who are in the hospitals & being treated for injury No one can predict ARDS ASSESSMENT Cigarette smoking More than 65 yrs of age PALPATION: TACTILE FREMITUS Chronic lung disease By placing the palm of the hand on various areas of the chest wall while the client repeats a phrase such as "ninety-nine," the nurse can feel for PATHOPHYSIOLOGY vibrations. Increased tactile fremitus can indicate consolidation, as seen in pneumonia. AUSCULTATION: Whispered Pectoriloquy Ask the patient to whisper a sequence of words such as “one-two-three,” and listen with a stethoscope. Normally, only faint sounds are heard. However, over areas of tissue abnormality, the whispered sounds will be clear and distinct. AUSCULTATION: Bronchophony Ask the patient to say "99" in a normal voice. Listen to the chest with a stethoscope. The expected finding is that the words will be indistinct. Bronchophony is present if sounds can be heard clearly. AUSCULTATION: Egophony While listening to the chest with a stethoscope, ask the patient to say the vowel “e”. Over normal lung tissues, the same “e” (as in "beet") will be heard. If the lung tissue is consolidated, the “e” sound will change to a nasal “a” (as in "say"). CAUSES Sepsis Shocks Trauma Neurological Injuries Burns Disseminated Intravascular Coagulation (common on pregnant women) Drug ingestion Aspiration Inhalation of toxic substance DIRECT INJURY o Burns (rapid fluid shifting from intra to extracellular) o Aspiration o Drug overdose o Chest Trauma *Something that is inhaled. Faith Depasupil BSN 4-D (2024-2025) 4  LECTURE | PRELIM NCM 118 Medical-Surgical Nursing (Care of Clients with Life-Threatening Conditions, Acutely Ill Multi Organ Problems, High Acuity and Emergency Situation) ASSESSMENT MEDICATION HALLMARK: Shunt – remains hypoxemia due to shunting (↑RR & Analgesics - morphine sulfate ↑WOB) Antacids: Aluminum Hydroxide (Kay NPO) Chest X-ray reveals bilateral infiltrates (WHITE CAST) Antibiotics Decreased lung compliance; increasing pressure required to ventilate Anticoagulants: Heparin, Warfarin patient using mechanical ventilator Diuretic: Furosemide (Loop diuretic) Sputum reveals the infectious organism o To decrease pulmonary edema Pulmonary artery catheter (swan- ganz catheter) readings: pulmonary o Check BP artery wedge pressure > 18 mmHg Exogenous Surfactant: Beractant Tachypnea Corticosteroid: Decrease inflammation ABG analysis on room air shows decrease PaO2 Inhaled Vasodilators Blood culture o Nitric oxide – Rescue Therapy Brain Natriuretic Peptide (BNP) ECG for CHF NURSING MANAGEMENT REMEMBER! Treat pt in ICU Adm O2 Acute pulmonary edema Fowler’s position Ratio (P/F