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Emphysema

Chronic Obstructive Pulmonary Diseases (COPD) Chronic Airflow Limitation (CAL). Emphysema . Loss of lung elasticity Hyperinflation of the lung Formation of Bullae Small airway collapse and air trapping. Classifying Emphysema.

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Emphysema

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  1. Chronic Obstructive Pulmonary Diseases (COPD) Chronic Airflow Limitation (CAL)

  2. Emphysema • Loss of lung elasticity • Hyperinflation of the lung • Formation of Bullae • Small airway collapse and air trapping

  3. Classifying Emphysema • Panlobular • Centrolobular

  4. Clinical Manifestations • Progressive dyspnea on exertion • Prolonged expiratory phase & tachypnea • Increased work of breathing • Anorexia, weight loss • Barrel Chest • Flattened diaphragm

  5. Clinical Manifestations (cont) • Formation of blebs and bullae • Hyperresonance • Polycythemia (pink puffer) • Chronic hypoxia • Pneumothorax • Hypercapnic to hypoxic drive • Chronic respiratory acidosis (end stage)

  6. Pulmonary Function Tests • Increased • residual volume • total lung capacity • Decreased • Forced vital capacity • FEV1

  7. Clubbing of Fingers

  8. Chronic Bronchitis • Excessive production of mucus in the bronchi • Productive cough • Persists 3 months of the year for 2 consecutive years

  9. Pathologic Changes • Chronic inflammation • Hypertrophy and hyperplasia of the mucus glands • Increased susceptibility to infection • V/Q changes

  10. Presentation • May have same symptoms as emphysema • Frequent respiratory infections • Cyanosis • Cor pulmonale • Polycythemia

  11. Asthma • Not always listed as one of the diseases of COPD/CAL • Asthma is usually a reversible process • Involves periodic episodes

  12. Asthma Classifications • Extrinsic (Allergic) • Antigen/antibody response • Childhood • Intrinsic (Endogenous) • History recurrent RTI • adulthood

  13. Pathologic Changes • Hypersensitivity response • Bronchoconstriction • May become chronic with irreversible changes

  14. Presentation • Bronchospasm • Increased mucus secretion • Dyspnea • Wheezing • Cough

  15. Consequences of CAL • ABG’s • Initially normal ABG followed by decreased PaO2 and O2 saturation • Increased PaCO2 with an increase in HCO3 to compensate • Compensated Respiratory Acidosis and Hypoxemia

  16. Polycythemia • Related to decreased PaO2 • What is the mechanism?

  17. Pulmonary Function Tests • What do you expect? TLC increased FEV1 decreased

  18. Cor Pulmonale COPD/CAL Pulmonary Vascular Bed Pulm Hypertension Hypoxemia RV Failure Polycythemia LV Failure

  19. Collaborative Management of CAL • Medical management • Maximize oxygenation, ventilation and perfusion • Surgical management • Bullectomy • Lung volume reduction surgery

  20. Drug Therapy • Bronchodilators • Sympathomimetics • Methylxanthines • Anticholinergics • Steroids • Mast Cell Stabilizers • Leukotriene Antagonists • Expectorants • Antibiotics

  21. Nursing Diagnoses • Impaired gas exchange • Ineffective airway clearance • Activity intolerance • Anxiety • Altered nutrition: less than body requirements

  22. Nursing Interventions • Maintain a patent airway • Safely administer oxygen • Use oxygen delivery systems appropriately • Accurately assess the patient’s breathing • Use positioning to improve oxygenation

  23. Teach the Patient: • Abdominal & Pursed lip breathing • Controlled coughing • Conservation of energy • Prevent secondary infection • Insure hydration • Nutrition • Therapeutic communication/relaxation

  24. Metered Dose Inhaler (MDI)

  25. Peak Flow Meter

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