COPD

COPD

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

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	Created by Hanaan Naanah almost 6 years ago