Chronic Obstructive Pulmonary Disease #1

Pathophysiology
1. Bronchitis (Blue Bloater)
  1. 1. Chronic Inflammation and swelling of bronchial mucosa results in scaring and increased fibrosis of the mucous membranes and hyperplasia of mucous glands and goblet cells.
    1. 2. Leads to thickenening of the bronchial walls
      1. 3. Obstruction of airflow
        4. Increased levels of eosinophils at site of inflammation
        5. Hypertropy of goblet cells leads to increased production of mucous
        6. Mucus production combined with purulent exudate forms a bronchial plug
        Often bacterial conolization contains bacteria of the H. influenza and S. pneumoniae groups
        7. Narrowed airway and mucous plugs lead to improper oxygenation, thus causing high airway resistance
        8. Increased oxygen demand (Perfusion and ventialation mismatch)
        9. Can lead to oxygen desaturation (cyanosis) due to the inabiltity to the alveoli exchanging CO2 for O2 slowly. This can lead to an abundance of alternative issues.
        Can also lead to right sided heart failure and edema
  2. (Schumann, 2013, p. 482)
2. Emphysema (Pink Puffer)
  1. 1. Reductions to the capillary bed occur due to smoking, enviromental pollutants and certain occupations.
    1. 2. Destroyed alveolar walls cause inflammation
      1. 3. Inflammation releases protolytic enzymes such as macrophages and neutrophils
        4. This loss of capillary bed causes reduced pulmonary abilities and causes the loss of elasticity
        5. Loss of elasticity leads to less exchange of gas and a increasing pressure around the airway lumen
        6. Leads to airway resistance and decreased airflow
        7. Air becomes trapped in distal alveoli and they become distended which can collapse with the pressure from airway obstruction
  2. (Schumann, 2013, p. 487)
3. Clinical Manifestations of COPD: Intermittent or productive Cough, sputum production, dyspnea
  1. Diagnostic
  2. ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
    1. Collabrative Practice
      1. There are 7 goals associated with managing AECOPD - Prevention progression - Reduce the frequency of exacerbation phases - Relieve breathlessness and respiratory symptoms - Improve exersise and daily activities - Treat exacerbation - Improve quality of life and health status - Reduce risk of mortality (Lewis, Heitkemper, Dirksen, Bucher, & Camera, 2014)
        someone with COPD mid 80s- low 90%. Oxygen can be dangerous and lead to further complications -Increased risk of hypoxemia due to lack of ability to effectively exchange CO2 for O2.
        Signs of Hypoxemia : Skin colour changes, Shortness of breath, confusion, wheezing, rapid heart rate, and rapid breathing.
        Smoking Cessation is a large focus for those with COPD and also those that are excperincing exacerbation. 80-90% of those with COPD were at one time a smoker. Smoking leads to an accelerated rate of pulmonary function decline. Thus causing a increased risk of exacerbation and risk of severe complications. (Lewis, Heitkemper, Dirksen, Bucher, & Camera, 2014)
        During exacerbation an individuals body can become decompensated due to the extreme conditions; improving this by ensuring adequate nutrition, exercise and deep breathing and coughing.
        In severe case of AECOPD surgical therapy many be indicated; -Lung volume reducation surgery; reduces the size of the hyper nflated emphysematous lungs by 20-25% - Lung transpalant if advanced.
        Drug Therapy A crucial part of managing AECOPD. The use of oral and parenteral corticosteroid use is a rapid methode that reduces the risk of relapse. (Carr, 2008) -A corticosteroid in AECOPD improves airflow and will recuce the likeliness of alternative treatment failures (Woods, Wheeler, Finch, & Pinner, 2014) - During a exacerbation period it often leads to a increased amount of drugs being used, and new ones being introduced this is to help quickly manage the symptoms and seek a new regimen.
        Ensure that client has recieved all vaccinations and their annual influenza and pneumoccacal vaccine
        Avoid exposures to large crowds in peak of influenza season
        Oxygen is a drug that should be used with caution
    2. THERAPEUTIC NURSING CARE
      1. HEALTH PROMOTION
        Avoid exposure to work and environmental pollutants and irratants
        Hand hygiene
        Avoid or quit smoking
        Avoid large crowds during peak influenza seasons
        Vaccinations
        Seek medical attention when change in baseline
        Early detection of airway disease and respiratory tract infections
      2. EDUCATION
        What is COPD?
        Nonpharmacological therapy: breathing exercises, pursed lip breathing, relaxation techniques, exercise.
        Medications and Correct Use of Inhalation Devices
        INAHLERS
        Psychosocial/Emotional Issues: dependency, intimacy, depression, anxiety, panic, support, rehabilitation groups.
        End of Life: identifying concerns, support decision making and planning
        Home Oxygen
        COPD Management
        Nutrition
      3. EXERCISE
        Energy Conserving Strategies
        Sexual Activity
        Sleep
        Psychosocial Considertions
    3. Infectious Triggers
      1. Most common cause of AECOPD
      2. H. influenza & S.pneumoniae
    4. Non-infectious Triggers
      1. Exposure to allergens, irrantants, cold air and air polutions

	Created by Brittlyn Burkholder almost 8 years ago

	Copied by Brittlyn Burkholder almost 8 years ago

	Copied by Rachel Hollywood almost 8 years ago

	Copied by Brittlyn Burkholder almost 8 years ago

	Copied by Brittlyn Burkholder almost 8 years ago

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Chronic Obstructive Pulmonary Disease #1

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