8003380
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Mind Map by Rachel Hollywood, updated more than 1 year ago
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Chronic Obstructive Pulmonary Disease UPDATED
- Pathophysiology
- BRONCHITIS (Blue bloater)
- 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.
- 2. Leads to thickenening of the bronchial walls
- 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
- Can also lead to right sided heart failure and edema
- 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.
- 8. Increased oxygen demand
(Perfusion and ventialation
mismatch)
- Often bacterial conolization contains bacteria of the H. influenza and S. pneumoniae
groups
- 6. Mucus production combined with
purulent exudate forms a bronchial
plug
- 5. Hypertropy of goblet cells leads to
increased production of mucous
- 4. Increased levels of eosinophils at site of
inflammation
- 3. Obstruction of
airflow
- 2. Leads to thickenening of the bronchial walls
- (Schumann, 2013, p. 482)
- 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.
- EMPHYSEMA (Pink Puffer)
- 1. Reductions to the capillary bed occur due to
smoking, enviromental pollutants and certain
occupations.
- 2. Destroyed alveolar walls cause inflammation
- 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
- 7. Air becomes trapped in distal alveoli and
they become distended which can collapse
with the pressure from airway obstruction
- 6. Leads to airway resistance and decreased airflow
- 5. Loss of elasticity leads to less exchange of gas and
a increasing pressure around the airway lumen
- 4. This loss of capillary bed causes reduced
pulmonary abilities and causes the loss of
elasticity
- 3. Inflammation releases protolytic enzymes such as
macrophages and neutrophils
- 2. Destroyed alveolar walls cause inflammation
- (Schumann, 2013, p. 487)
- 1. Reductions to the capillary bed occur due to
smoking, enviromental pollutants and certain
occupations.
- Clinical Manifestations of COPD:
Intermittent or productive
cough, sputum production,
dyspnea
- DIAGNOSTIC: COPD is diagnosed based on risk
factors and symptoms. COPD is confirmed by
a spirometry test. This allows COPD to be
classified from mild to very severe. Specifcally,
the FEV ratio of less than 70% indicates COPD.
- ACUTE EXACERBATION OF CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
- COLLABORATIVE PRACTICE
- 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.
- 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
- Avoid exposures to large crowds in peak of influenza season
- Oxygen is a drug that should be used with
caution
- Ensure that client has recieved all vaccinations and their annual influenza and pneumoccacal
vaccine
- 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.
- 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)
- THERAPEUTIC NURSING CARE
- 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
- Early detection of airway disease
and respiratory tract infections
- Avoid exposure to work
and environmental
pollutants and irratants
- EDUCATION
- Nonpharmacological therapy:
breathing exercises, pursed lip
breathing, relaxation
techniques, exercise.
- What is COPD? Medications
and correct use of inhalation
devices. Home oxygen.
- Psychosocial/Emotional
Issues: dependency,
intimacy, depression,
anxiety, panic, support,
rehabilitation groups.
- End of Life:
identifying
concerns, support
decision making
and planning
- COPD Management
- It is important to have a written action plan, which will include monitoring signs
and symptoms. Immediately reporting changes and recongnizing signs and
symptoms of infection are important in mangaging COPD. The following is a
resource used to plan the car e of COPD.
http://www.respiratoryguidelines.ca/sites/all/files/CTS_COPD_updated_Action_Plan_editable_PDF.pdf
- It is important to have a written action plan, which will include monitoring signs
and symptoms. Immediately reporting changes and recongnizing signs and
symptoms of infection are important in mangaging COPD. The following is a
resource used to plan the car e of COPD.
http://www.respiratoryguidelines.ca/sites/all/files/CTS_COPD_updated_Action_Plan_editable_PDF.pdf
- NUTRITION High protein and high
calorie diets are encouraged, as
the high calorie and protein
prevent weight loss and muscle
wasting. Weight loss can occur
due to the lowered energy,
increased work of breathing and
shortness of breath.
- Nonpharmacological therapy:
breathing exercises, pursed lip
breathing, relaxation
techniques, exercise.
- EXERCISE
- Energy Conserving Strategies
- Strategies include using alternative techniques to complete
ADLs. It is reccommended that care that uses the upper
extremities, like shaving, hair care, etc. is down sitting
down in a tripod posture (elbows being supported), while a
mirror is placed on the table in front. It is also important
for a patient to have their oxygen on during times of
activity to conserve energy. Patients are encouraged to
exhale when doing activity.action, and inhale on rest.
- Strategies include using alternative techniques to complete
ADLs. It is reccommended that care that uses the upper
extremities, like shaving, hair care, etc. is down sitting
down in a tripod posture (elbows being supported), while a
mirror is placed on the table in front. It is also important
for a patient to have their oxygen on during times of
activity to conserve energy. Patients are encouraged to
exhale when doing activity.action, and inhale on rest.
- Sexual Activity
- It is recommended that to help conserve
energy, patients with COPD have sexual
activity during a time that their breathing is
at best. During sexual activity it is
important for the patient to practice slow
pursed-lip breathing, and to refrain from
sexual activity after eating or other
strenuous activities.
- It is recommended that to help conserve
energy, patients with COPD have sexual
activity during a time that their breathing is
at best. During sexual activity it is
important for the patient to practice slow
pursed-lip breathing, and to refrain from
sexual activity after eating or other
strenuous activities.
- Sleep
- Psychosocial Considertions
- Patients often have a range of emotions when dealing
with a COPD diagnosis or a complication (AE). It is difficult
for patients to come to terms with the reality that they
are unable to do activities or care for themselves like
they did. Nurses are to provide emotional support, and
provide therapeutic interventions like relaxation
techniques.
- Patients often have a range of emotions when dealing
with a COPD diagnosis or a complication (AE). It is difficult
for patients to come to terms with the reality that they
are unable to do activities or care for themselves like
they did. Nurses are to provide emotional support, and
provide therapeutic interventions like relaxation
techniques.
- Energy Conserving Strategies
- HEALTH PROMOTION
- Infectious Triggers
- Most common cause of AECOPD
- H. influenza &
S.pneumoniae
- Most common cause of AECOPD
- Non-infectious Triggers
- Exposure to allergens,
irrantants, cold air and air
polutions
- Exposure to allergens,
irrantants, cold air and air
polutions
- COLLABORATIVE PRACTICE
- DIAGNOSTIC: COPD is diagnosed based on risk
factors and symptoms. COPD is confirmed by
a spirometry test. This allows COPD to be
classified from mild to very severe. Specifcally,
the FEV ratio of less than 70% indicates COPD.
- BRONCHITIS (Blue bloater)
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