Chronic Chronic obstructive obstructive pulmonary pulmonary

diseasedisease((COPDCOPD))

Dr. Walaa NasrDr. Walaa NasrLecturer of Adult Nursing Lecturer of Adult Nursing

Second year Second year

COPDCOPD Out linesOut lines What is the COPD?What is the COPD? OverviewOverview Causes of COPDCauses of COPD Symptoms of COPDSymptoms of COPD What's the difference between COPD What's the difference between COPD

and asthma?and asthma? Diagnostic tests needed for COPDDiagnostic tests needed for COPD Medical management of COPDMedical management of COPD Preventive measuresPreventive measures Nursing interventionNursing intervention Outlook and PrognosisOutlook and Prognosis

COPDCOPD DefinitionDefinition

COPDCOPD, or chronic , or chronic obstructive pulmonary obstructive pulmonary disease, is a progressive disease, is a progressive disease that makes it disease that makes it hard to breathe. hard to breathe. "Progressive" means the "Progressive" means the disease gets worse over disease gets worse over time.time.

COPDCOPD OverviewOverview

COPDCOPD OverviewOverview

In COPD, less air flows in and out of the airways because of one or more of the following:

The airways and air sacs lose their elastic quality.

The walls between many of the air sacs are destroyed.

The walls of the airways become thick and inflamed.

The airways make more mucus than usual, which tends to clog them.

COPDCOPD CausesCauses

SmokingSmokingAir pollutionAir pollutiongenetic genetic (hereditary) (hereditary) risk risk

COPDCOPD SymptomsSymptoms

Productive cough Breathlessness Chest infection Other symptoms of COPD can be more vague, weight loss, tiredness and ankle swelling.

Difference between COPD and Asthma

In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are chronic (persistent). Treatment to open up the airways, is therefore limited.

In asthma there is inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well.

COPD is more likely than asthma to cause a chronic (ongoing) cough with sputum.

Difference between COPD and asthma (cont…)

Night time waking with Night time waking with breathlessness or wheeze is breathlessness or wheeze is common in common in asthma asthma and uncommon and uncommon in COPD.in COPD.

COPDCOPD is rare before the age of 35 is rare before the age of 35 whilst asthma is common in under-whilst asthma is common in under-35.35.

COPDCOPD Diagnostic tests

Symptoms Physical examination Sample of sputum Chest x-ray High-resolution CT (HRCT scan) Pulmonary function test

(spirometery) Arterial blood gases test Pulse oximeter

COPDCOPD Medical management

Give antibiotics to treat infection

Give bronchodilators to relieve bronchospasm, reduce airway obstruction, mucosal edema and liquefy secretions.

Chest physiotherapy and postural drainage to improve pulmonary ventilation.

Proper hydration helps to cough up secretions or tracheal suctioning when the patient is unable to cough.

Steroid therapy if the patient fails to respond to more conservative treatment.

COPDCOPD Medical management (cont…)

SStop smokingtop smoking

OOxygenation with low concentration during the acute xygenation with low concentration during the acute episodesepisodes

InIn asthma adrenaline ( epinephrine) SC if the bronchospasm asthma adrenaline ( epinephrine) SC if the bronchospasm not relieved.not relieved.

AAminophylins IV if the above treatment does not help.minophylins IV if the above treatment does not help.

IVIV corticosteroids for patients with chronic asthma or corticosteroids for patients with chronic asthma or frequent attack.frequent attack.

SSedative or tranquilizers to calm the patient.edative or tranquilizers to calm the patient.

IIncrease fluids intake to correct loss of diaphoresis and ncrease fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation.inaccessible loss of hyperventilation.

IIntubations and mechanical ventilation if there is respiratory ntubations and mechanical ventilation if there is respiratory failurefailure..

To prevent irritation and infection of the To prevent irritation and infection of the airways, instruct the patient to:airways, instruct the patient to:

Avoid exposure to cigarette, pipe, and Avoid exposure to cigarette, pipe, and cigar smoke as well as to dusts and cigar smoke as well as to dusts and powders.powders.

Avoid use of aerosol sprays.Avoid use of aerosol sprays.

Stay indoors when the pollen count is Stay indoors when the pollen count is high.high.

Stay indoors when temperature and Stay indoors when temperature and humidity are both highhumidity are both high

COPDPreventive measures

Use air conditioning to help decrease pollutants and control temperature

Avoid exposure to persons known to have colds or other respiratory tract infection

Avoid enclosed, crowded areas during cold and flu season.

Obtain immunization against influenza and streptococcal pneumonia.

COPDPreventive measures (cont…)

COPDPreventive measures (cont…)

To ensure prompt, effective treatment To ensure prompt, effective treatment of a developing respiratory infection, of a developing respiratory infection, instruct the patient to do the instruct the patient to do the following:-following:-

Report any change in sputum color Report any change in sputum color character, increased tightness of the character, increased tightness of the chest, increased dyspnea, or fatigue.chest, increased dyspnea, or fatigue.

Call the physician if ordered antibiotics Call the physician if ordered antibiotics do not relieve symptoms within 24 do not relieve symptoms within 24 hours.hours.

COPDNursing interventionNursing intervention

Assessment Assessment HistoryHistory Patient's environmentPatient's environment Work history, exercise Work history, exercise

pattern, smoking habitspattern, smoking habits The onset & development of The onset & development of

symptomssymptoms Sleeping positionsSleeping positions

COPDNursing intervention (cont…)Nursing intervention (cont…)

Physical examinationSigns of heavy smokers Observe for clubbing Distended neck vein on expiration The presence of barrel chest Observe for abdominal breathing The use of pursed lips breathing

and chest movement Auscultate the chest& listen for

musical wheezes characteristics of chronic bronchitis

COPDNursing intervention (cont…)Nursing intervention (cont…)

review the results of diagnostic procedure: Arterial blood gases Pulmonary function tests X-ray films Nursing diagnosis

Ineffective breathing pattern related to increase need of O2

Ineffective airway clearance related to excessive accumulation of secretions

Impaired gas exchange related to impaired expiration &co2 retention

COPDNursing intervention (cont…)Nursing intervention (cont…)

Activity intolerance related to inadequate oxygenation

High risk for ineffective individual coping related to chronic disease, its effects& its treatment

High risk for altered health maintenance

related to insufficient knowledge of prevention, identification and treatment of respiratory complication of COPD