Zusammenfassung der Ressource
COPD
- PATHOPHYSIOLOGY
- Emphysema "Pink Puffer"
- Decrease aveoli
elasticity in
connective tissue
of lungs
- Airway instability
- Increase lung compliance
- Chronic Bronchitis "Blue Bloaters"
- Bronchial
inflammation +
edema
- Mucus hypersecretion
- Bronchospasms
- Airway obstruction, Air
trapping
- Hypoxia
- Polycythemia
- Increased thickness of blood
- Pulmonary vasoconstriction
- increase pulmonary vasculature
resistance
- Pulmonary hypertension
- Hypertrophy of right ventricle
- Cor
pulmonale
- Right sided heart failure
- Hypercapnia
- Respiratory acidosis
- Hypoxemia
- Cyanosis
- CLINICAL OBSERVATIONS
- Etiology
- Heredity
- Smoking
- Chemical + Air
pollutants
- Infection
- Age
- Symptoms
- Anorexia
- Difficulty eating
- Decrease levels of ADLs
- Dyspnea
- Orthopnea
- Productive cough
- Fatigue
- Headaches
- Wheezing
- Bloating
- Swelling of
feet
- DIAGNOSIS
- ABG
findings
- Low PaO2; ↑ PaCO2 (> 45 mmHg) ;↓
pH (< 7.35); ↑Bicarbonate level
found in late stages of COPD (> 26
mmHg)
- Pulmonary tests
- Chest X-ray
- Spirometry
- Oximetry
- Dyspnea Scale
- Walk test determines oxygen
desaturation in blood
- Patient health
hx.
- Family history of COPD
- AAT
deficiency
- Body is unable to make
enough proteins to protect
the lungs and liver from
damage; may lead to
emphysema and/or liver
disease
- Hx./frequency of respiratory infections; hx. of resp. and cardiac problems
- ECG
findings
- ST depression + T inversion;
RHF
- TREATMENTS
- Drug therapy
- Corticosteroid
- Prescribed for
moderate to severe
forms of COPD
- Inhaler
- Pills
- Combination
medicines
- Inhalers that
combine a
bronchodilator and a
corticosteroid help
to treat and prevent
COPD exacerbations
- fluticasone +
salmeterol
- fluticasone furoate + vilanterol trifenatate
- budesonide + formoterol fumarate
- Bronchodilators
- Aids by opening the
airways in the lungs,
thus making it easier
to breath
- Rapid-onset bronchodilators:
relieves SOB in few minutes
- Slow-onset bronchodilators:
take longer to act (i.e., 4-6 hrs,
and some lasting 24 hrs)
- Beta-2
agonists
- Anticholinergics
- Oxygen
therapy
- Effective for those with low
blood-oxygen levels (hypoxemia)
and/or those with lung damage due
to infections (i.e., pneumonia)
- Reduces workload on
the heart and work of
breathing
- Surgical
therapy
- Lung transplantation
- Usually a single
lung
transplantation;
aids in
improving
quality of life
- Lung volume reduction surgery
- Removal of the
damaged lung
to improve
respiratory
function
- Bullectomy
- Surgical removal
of a bulla to
improve
symptoms and
respiratory
function for those
with emphysema
- Nutritional therapy
- Breathing requires a lot of energy for
those with COPD as muscles use 10x
more calories than those without
COPD
- Having a high calorie & high protein diet
- Eat small meals (~ 5-6 meals) to avoid bloating
- Calorie increasing desserts such as ice cream can aid supplementary intake
- Avoid foods that require a lot of chewing
- Exercise & treatment 1 hr before and after eating
- Gas-forming foods
- AVOID!
- Nursing Management
- Assessment
- Obtain patients complete health history +
physical assessment; collecting subjective +
objective data
- Planning
- Formulate patient goals:
improve QoL, prevent
disease progression, assess
patient knowledge and
ability to perform long-term
goals, relieve symptoms
- Evaluation
- Expected Outcomes:
improved sleep cycle,
maintaining body weight,
effective coughing,
normal breath sounds
- Implementation
- Health Promotion:
smoking cessation,
family hx. of COPD &
AAT deficiency
- Acute intervention:
due to secondary
causes (i.e.,
pneumonia, acute
resp. failure, cor
pulmonale)
- Ambulatory care & Home Care:
perform exercises (i..e, walk 15-20
mins/day for at least 3x a week),
instruct pt. to wait 5 mins after
finishing the exercise before using
bronchodilators and instead
allocate for slow pursed-lip
breathing
- COMPLICATIONS
- Infection + air pollution
- Changes in dyspnea/cough/sputum
- Exacerbations of COPD
- Discontinuation of corticosteroid and/or bronchodilators
- overuse of sedatives /benzodiazapenes/opiods
- Depression/anxiety
- Surgery or severe painful illness involving chest or abdomen
- Peptic ulcer disease
- Acute respiratory failure
- an irreversible, slow,
progressive obstruction of
airflow into and/or out of
the lungs mainly due to an
abnormal inflammatory
response from the lungs