1 / 22

Management of Patients With Chronic Pulmonary Disease

Management of Patients With Chronic Pulmonary Disease. COPD:. Chronic Obstructive Pulmonary Disease A disease state characterized by airflow limitation that is not full reversible (GOLD). COPD is the currently is 4 th leading cause of death and the 12 th leading cause of disability.

martha
Download Presentation

Management of Patients With Chronic Pulmonary Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Management of Patients With Chronic Pulmonary Disease

  2. COPD: • Chronic Obstructive Pulmonary Disease • A disease state characterized by airflow limitation that is not full reversible (GOLD). • COPD is the currently is 4th leading cause of death and the 12th leading cause of disability. • COPD includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these disorders. • Asthma is now considered a separate disorder but can coexist with COPD.

  3. Pathophysiology of COPD • Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious agents. • Inflammatory response occurs throughout the airways, lung parenchyma, and pulmonary vasculature. • Scar tissue and narrowing occurs in airways. • Substances activated by chronic inflammation damage the parenchyma. • Inflammatory response causes changes in pulmonary vasculature.

  4. Chronic Bronchitis • The presence of a cough and sputum production for at least 3 months in each of 2 consecutive years. • Irritation of airways results in inflammation and hypersecretion of mucous. • Mucous-secreting glands and goblet cells increase in number. • Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways. • Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes. • The patient is more susceptible to respiratory infections.

  5. Pathophysiology of Chronic Bronchitis

  6. Emphysema: • Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli. • Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion. • Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures. • Hypoxemia result of these pathologic changes. • Increased pulmonary artery pressure may cause right-sided heart failure (corpulmonale).

  7. Changes in Alveolar Structure with Emphysema

  8. Risk Factors for COPD • Tobacco smoke causes 80-90% of COPD cases! • Passive smoking • Occupational exposure • Air pollution • Genetic abnormalities(2% of cases) • Alpha1-antitrypsin deficiency ( enzyme inhibitor that protect the lung parenchyma from injury)

  9. Clinical Manifestation • 3 primary symptoms: • Chronic cough • Sputum production • Dyspnea on exertion • Wt loss • Barrel chest (A-P diameter/ Transverse diameter : 2/1) • Retraction in the supraclavicular area on inspiration • Shrug shoulder • Abdominal muscle contraction on inspiration (paradox respiration) .

  10. Normal Chest Wall and Chest Wall Changes with Emphysema

  11. Typical Posture of a Person with COPD

  12. Medical Management • Risk reduction • Pharmacologic therapy • Management of exacerbation • O2 therapy • Surgical management • Pulmonary rehabilitation

  13. Nursing Process: The Care of Patients with COPD- Assessment • Health history • Inspection and examination findings • Review of diagnostic tests

  14. Nursing Process: The Care of Patients with COPD- Diagnoses • Impaired gas exchange • Impaired airway clearance • Ineffective breathing pattern • Activity intolerance • Deficient knowledge • Ineffective coping

  15. Collaborative Problems • Respiratory insufficiency or failure • Atelectasis • Pulmonary infection • Pneumonia • Pneumothorax • Pulmonary hypertension

  16. Nursing Process: The Care of Patients with COPD- Planning • Smoking cessation • Improved activity tolerance • Maximal self-management • Improved coping ability • Adherence to therapeutic regimen and home care • Absence of complications

  17. Improving Gas Exchange • Proper administration of bronchodilators and corticosteroids • Reduction of pulmonary irritants • Directed coughing, “huff” coughing • Chest physiotherapy • Breathing exercises to reduce air trapping • diaphragmatic breathing • pursed lip breathing • Use of supplemental oxygen

  18. Improving Activity Tolerance • Focus on rehabilitation activities to improve ADLs and promote independence. • Pacing of activities • Exercise training • Walking aides • Utilization of a collaborative approach

  19. Other Interventions • Set realistic goals • Avoid extreme temperatures • Enhancement of coping strategies • Monitor for and management of potential complications

  20. Patient Teaching • Disease process • Medications • Procedures • When and how to seek help • Prevention of infections • Avoidance of irritants; indoor and outdoor pollution, and occupational exposure • Lifestyle changes, including cessation of smoking

More Related