Obstructive Lung DiseaseKimberlyAugustine BSRN

Objectives

Define Obstructive Lung Disease Epidemiology Pathophysiology Identify Clinical manifestations Identify Risk factors Discuss Evaluation & Treatment

Definition Several different definitions have existed for COPD.

“A disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.”-GOLD

A group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema, chronic bronchitis, and in some cases asthma.-CDC

“Airway obstruction:most common obstructive diseases are asthma, chronic bronchitis, emphysema-McCane & Huether

Obstructive Pulmonary Disease

Obstructive Diseases

Include:

Chronic bronchitis

Emphysema

Asthma

Epidemiology

4th leading cause of death in the U. S. 12.1 million U.S. adults were estimated

to have COPD Women have exceeded men in the

number of deaths attributable to COPD 2010, $49.9 billion COPD health care

costs Worldwide leading cause of death &

disability 2020, predicted 3rd leading cause of death

Pathophysiology: Video

http://www.youtube.com/watch?v=lYW_2Rfuii8&feature=related

Obstructive Lung Disease: Emphysema

“ A condition which the lungs lose elasticity and alveoli enlarge that disrupts function”

Destruction of lung parenchyma Loss of elastic recoil Alveolar gas is trapped in expiration Gas exchange is compromised

Pathophysiology: Emphysema

Begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood.

The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.

As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath.

The lungs also lose their elasticity, which is important to keep airways open. The patient experiences great difficulty exhaling.

COPD: Emphysema

COPD: EmphysemaSigns & Symptoms

Dyspnea Little sputum production or cough Tachypnea with prolonged expiration Use of accessory muscles for ventilation Increased anteroposterior diameter of thorax (Barrel

Chest) Pierced Lips to prevent expiratory airway collapse Cardiac enlargement Hyperresonant (loud, low) sound with chest percussion

d/t hyperinflation

Obstructive Lung Disease: Chronic Bronchitis

“The presence of a mucus-producing cough three months of a year for two consecutive years without other underlying disease to explain the cough.”

Inflammation and eventual scarring of the lining of the bronchial tubes

Inflamed, infected bronchi allow for less air to flow to and from the lungs and a heavy mucus or phlegm is coughed up

Pathophysiology: Chronic Bronchitis Increased mucous production Increase in size, number goblet cells Impaired Ciliary function Bronchospasm, permanent narrowing of airways Decreased ventilation Tidal Volume Decreased Hypoventilation Hypercapnia

COPD: Chronic Bronchitis

COPD: Chronic BronchitisSigns & Symptoms

Wheezing and shortness of breath Productive cough “smoker's cough” Decreased tolerance, hypoxic with exercise Frequent pulmonary infections Decreased FEV1, FEC FRC & RV increased Increased Paco2, Hypoxemia, Polycythemia Cyanosis “Blue Bloater”

Risk Factors: COPD (Emphysema & Chronic Bronchitis)

Smoking predominant Cause Alpha-1antitrypsin deficiency Occupational exposure, pollution Diet deficient in vitamin C Low Birth weight Childhood respiratory infections Pre-existing bronchial hyper-responsiveness Low social class

Global Initiative: COPD

Potential Complications: COPD

Hypoxemia (paO2 of 55mmHg or less with an oxygen saturation of 85% or less)

Cor Pulmonale (Right Sided Heart Failure) Respiratory Acidosis & Hypercapnia (increased

paCO2):

Oxyhemoglobin Dissociation Curve

The oxyhemoglobin dissociation curve is an important tool for understanding how our blood carries and releases oxygen. Specifically, the oxyhemoglobin dissociation curve relates oxygen saturation (SO2) and partial pressure of oxygen in the blood (PO2), and is determined by what is called "hemoglobin's affinity for oxygen," that is, how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue.

Potential Complications: COPD

Hypoxemia (paO2 of 55mmHg or less with an oxygen saturation of 85% or less)

– Mood changes

– Forgetfulness

– Inability to concentrate

– Cyanosis a late sign of hypoxia

Potential Complications of COPD Respiratory Acidosis & Hypercapnia (inc.

pCO2):

– Decrease in oxygen/carbon dioxide exchange

– Rising carbon dioxide levels result in respiratory acidosis (CO2 makes ACID)

– SOB (increased Respiratory rate)

– Headache

– Confusion

– Lethargy

– Nausea and Vomiting

Potential Complications COPD

Cor Pulmonale (Right Sided Heart Failure)

– Progressive shortness of breath with activity

– Chest pain under sternum

– Weakness

– Neck vein distention, edema

– Enlarged liver

– Right ventricular hypertrophy

Obstructive Lung Disease: Asthma“Chronic inflammatory disorder of the airways

involving hyper-responsiveness and airway obstruction”

Periods of attacks of wheezing shortness of breath

Tight feeling in the chest

Cough that produces mucous

Due to an allergic reaction

Triggered by certain drugs, irritants, viral infection, exercise emotional stress

Pathophysiology: Asthma

Familial Allergen Exposure initiates immune response IL-4 activates IgE production, mast cell

degranulation Releases histamine, prostaglandins, leukotrienes Bronchospasm, congestions, mucous production Bronchial Hyper-responsiveness

Asthma: Signs & Symptoms

Asymptomatic between attacks Chest constriction Expiratory Wheezing Dyspnea Non productive cough Tachycardia, tachypnea Pulsus Paradoxus

Asthma: Signs & Symptoms (Cont.)

Hypoxemia with low pCO2 Respiratory fatigue/failure: pco2 may rise Eosinophilia (allergy) Decreased FEV1 Decreased peak expiratory flow rate

Risk Factors: Asthma

Asthma: EvaluationTreatment

Treat precipitating event Oxygen therapy Hydration Antibotics (with infection) Meds: bronchodilators, steroids, mast cell

stabilizers, methylxanthines

Nursing Diagnosis: COPD

Ineffective airway clearance r/t Airway spasm Retained secretions Excessive mucous Fatigue

Impaired gas exchange r/t Descreased lung expansion Decreased LOC Presence of pulmonary secretions

Nursing Diagnosis: COPD

Ineffective breathing patterns r/t Hyperventilation Hypoventilation Anxiety fatigue

Planning (Goals)

Breath sounds clear A&P Respirations between 12-20/min SaO2 90% or greater Ambulate ___ feet QID

Implementation: Promoting Lung expansion

Positioning Breathing exercises Chest Physiotherapy Oxygen Therapy

Implementation: Promoting Lung expansion

Positioning: change at least Q2 hrs

Implementation: Promoting Lung expansion

Breathing exercises: to expel secretions from lungs

CDB Q2 hrs Pursed lip breathing

Helps COPD patients to evacuate more air by breathing out against pressure

Abdominal Breathing (diaphragmatic) Promotes alveoli expansion and emptying

Implementation: Mobilizing Pulmonary Secretions

Hydration Keeps pulmonary secretions moist, easy

to expectorate Fluid intake 1500-2000 cc/day

Humidification Air or oxygen with increased humidity

will help to keep airways moist to loosen and mobilize pulmonary secretions

Nebulization Adding fine drops of moisture to the

respiratory tract

Implementation: Mobilizing Pulmonary Secretions

Chest physiotherapy Chest percussion (cupping)

Vibration: fine shaking pressure applied to chest wall only during exhalation (helps get rid of trapped air) vest

Implementation: Mobilizing Pulmonary Secretions

Chest physiotherapy Postural Drainage:

positioning

(not good for emphysema/bronchitis don’t tolerate asthma not needed. Just for CF-bronchitis w/o emphesema

Case Study

Journal Article: COPDthe role of the nurse by Barnett

Nurses have a key role

in the prevention and

treatment of COPD in

advising and

supporting patients

living with this

condition.

Nurses Role

Prevention & Treatment Recognize clinical symptoms Recognize Associated Risk Factors Medications Available

Effectiveness(Questions)

Patient Education: Smoking Nutrition Activity Vaccination

Discussion

Patient Factors for COPD/Single Most Factor

Clinical Manifestations of Bronchitis/Emphysema

COPD Staging

Arterial Blood Gas indicative of which Serious Condition

Pulmonary HTN/Cor Pulmonale Clinical Manifestations

Restrictive vs Obstructive Disease

http://www.youtube.com/watch?v=wbcjFpyxkpc&feature=related http://www.youtube.com/watch?v=wbcjFpyxkpc&feature=related

References

Barnett, Margaret.  (2006, February). COPD: the role of the nurse. Journal of Community Nursing, 20(2), 18-20,22.  Retrieved October 26, 2010, from Research Library. (Document ID: 989426231).

Bauldoff, G. (2009). When breathing is a burden: how to help patients with COPD. American Nurse Today, 4(9), 17-22. Retrieved from CINAHL

database.

National Heart Lung and Blood Institute http://www.nhlbi.nih.gov/health/public/lung/copd/.

American Lung Association http://www.lungusa.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html