CARE OF PATIENT WITH COPD Chronic Obstructive Pulmonary Disease

1. CARE OF PATIENT WITH COPDChronic Obstructive Pulmonary Disease

2. Objectives Define COPD. Identify causes of COPD. List the signs and symptoms of COPD. Describe the management and care for COPD. List the complications of COPD. Discuss relevant patient / family education.

3. Definition Chronic obstructive pulmonary disease (COPD) is a group of conditions causing the chronic or recurrent obstruction of airflow. It can result from the combination of symptoms associated with: Chronic bronchitis Emphysema Asthma

4. Causes The leading cause of COPD is smoking, which can lead to the two most common forms of this disease, emphysema and chronic bronchitis. Rarely, an enzyme deficiency called alpha-1 anti-trypsin deficiency can cause emphysema in non-smokers.

5. Chronic Bronchitis

6. Emphysema

7. Asthma 

8. Nursing Assessment Nasal flaring Cyanosis Dyspnea Decreased respiratory effort Decreased LOC Accessory muscle use Decreased breath sounds Decreased oxygen saturation

9. Signs and Symptoms COPD Conditions Chronic bronchitis Dyspnea Cyanosis Prolonged expiration Scattered crackles, rhonchi and wheezing Cardiac dysrhythmias Increased mucus production Productive cough Increased anterior-posterior diameter Peripheral edema Normal respiratory rate

10. Signs and Symptoms COPD Conditions Emphysema Dyspnea Barrel chest Use of accessory muscles Increased AP diameter of chest Decreased BS with expiratory wheezes Patient may look pink and puffy Tachypnea Leans forward while sitting Breathing through pursed lips

11. Signs and Symptoms COPD Conditions Asthma Prolonged expiratory time Pursed lips Wheezing with decreased breath sounds Cough May have upper airway rhinitis, sinusitis or nasal polyps Dyspnea Decreased PEFR Accessory muscle use Increased work of breathing Decreased oxygen saturation

12. Contributing Factors Associated With COPD History of smoking Occupation (certain occupations have increased risk for lung disease related to environmental work conditions) History of lung disease Allergies Recent pulmonary infection

13. CXR - positive findings include hyperinflation of the lung, cardiac enlargement, flattened diaphragm, congested lung fields PEFR (peak expiratory flow rate) - will measure the expiratory ability and help assess condition improvement after treatment.Pulse oximetry ABG - decreased pao2; Increased pco2 Diagnostic Procedures

14. Diagnostic Procedures CBC with differential - increased WBC indicative of infection; eosinophilia indicative of asthma Sputum cultures - specifically identify infectious agent Enzymes - may show decreased level of antitrypsin

15. Nursing Interventions Allow the patient to assume a position of comfort for easiest breathing. Begin O2 therapy based on the patient's condition. Continue to monitor oxygen delivery, especially if the patient is showing signs of chronic bronchitis. High-flow oxygen could cause the opposite effect desired, making the patient lose the drive to breathe. A Venturi mask is the most precise method of delivering exact amounts of oxygen.

16. Nursing Interventions Continuously monitor vital signs, including oxygen saturation. Prepare for more aggressive measures in case the patient's condition worsens. Greater ventilatory support may become necessary. Continuously monitor for cardiac dysrhythmias.

17. Nursing Interventions If the patient is in respiratory failure, begin high-flow oxygen delivery regardless of history. Obtain IV access. Fluids are frequently given to help liquefy secretions.

18. Nursing Interventions Commonly ordered medications include: 1. Nebulized inhalers - medication is inhaled by the patient. 2. Bronchodilator - stimulates b-receptors for bronchodilation. Medication is inhaled through the mouth. The dosage differs, based on the type of bronchodilator used as well as the patient's age and acute or chronic condition.

19. Nursing Interventions 3. Corticosteroids - decrease inflammation of epithelial cells in asthma. 4. Antibiotics may also be given if an infectious process is suspected. Administer as ordered by the physician, and discuss administration with the patient to ensure that antibiotic therapy is continued when the patient is released, if needed.

20. Patient Management Helpful breathing techniques, such as pursed-lip and diaphragmatic breathing How to position the patient's body for optimal air exchange Changing eating habits so he or she eats small, frequent meals rather than large meals

21. Patient Management The importance of exercise The need to cough up sputum Keeping the body hydrated Avoiding known triggers Medication compliance

22. Complications A prompt, accurate assessment to identify signs and symptoms of COPD, combined with the appropriate treatment, can help prevent serious complications associated with this condition.

23. Respiratory acidosis

24. Alternative Names    Chronic respiratory acidosis; Ventilatory failure; Respiratory failure; Acidosis - respiratory

25. Definition   Respiratory acidosis occurs when the lungs cannot remove all of the carbon dioxide (a normal by-product of metabolism) produced by the body. Because of this disturbance of the acid-base balance, body fluids become excessively acidic.

26. Causes Nearly any lung disease may lead to respiratory acidosis. Chronic obstructive pulmonary disease (COPD) is a major cause of respiratory acidosis. COPD is most often caused by cigarette smoking.

27. Symptoms  Symptoms of the diseases that cause respiratory acidosis are usually noticeable, and may include shortness of breath, easy fatigue, chronic cough, or wheezing. When respiratory acidosis becomes severe, confusion, irritability, or lethargy may be apparent.

28. Signs A chest x-ray or CAT scan may be done to diagnose possible lung disease Pulmonary function tests may help diagnose lung disease Arterial blood gases help assess the severity of the respiratory acidosis, and may detect abnormal oxygen levels

29. Nursing Care Smoking cessation is extremely important Bronchodilator drugs may reverse some airway obstruction Oxygen may be necessary if the blood oxygen level is low Non-invasive positive-pressure ventilation or mechanical ventilation may be necessary if the respiratory acidosis is severe

30. Complications    Respiratory acidosis may be a sign of respiratory failure, with dangerously low blood oxygen levels. Excessive respiratory acidosis may lead to confusion, lethargy, or poor organ function -- in extreme cases, low blood pressure and shock may result.

31. Patient & Family Education Call your health care provider if you have symptoms of lung disease. Call 911 or get to an emergency room if you suspect you have severe respiratory acidosis -- this is a MEDICAL EMERGENCY.

32. Patient & Family Education Not smoking -- or quitting if you smoke -- can prevent the development of many severe lung diseases that can lead to respiratory acidosis. Obese patients may prevent obesity hypoventilation syndrome by losing weight