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Chronic Obstructive Pulmonary Diseases (COPD) Chronic Airflow Limitation (CAL) Emphysema • • • • Loss of lung elasticity Hyperinflation of the lung Formation of Bullae Small airway collapse and air trapping Classifying Emphysema • Panlobular • Centrolobular Clinical Manifestations • Progressive dyspnea on exertion • Prolonged expiratory phase & tachypnea • Increased work of breathing • Anorexia, weight loss • Barrel Chest • Flattened diaphragm Clinical Manifestations (cont) • • • • • • • Formation of blebs and bullae Hyperresonance Polycythemia (pink puffer) Chronic hypoxia Pneumothorax Hypercapnic to hypoxic drive Chronic respiratory acidosis (end stage) Pulmonary Function Tests • Increased – residual volume – total lung capacity • Decreased – Forced vital capacity – FEV1 Clubbing of Fingers Chronic Bronchitis • Excessive production of mucus in the bronchi • Productive cough – Persists 3 months of the year for 2 consecutive years Pathologic Changes • Chronic inflammation • Hypertrophy and hyperplasia of the mucus glands • Increased susceptibility to infection • V/Q changes Presentation • May have same symptoms as emphysema • Frequent respiratory infections • Cyanosis • Cor pulmonale • Polycythemia Asthma • Not always listed as one of the diseases of COPD/CAL • Asthma is usually a reversible process • Involves periodic episodes Asthma Classifications • Extrinsic (Allergic) – Antigen/antibody response – Childhood • Intrinsic (Endogenous) – History recurrent RTI – adulthood Pathologic Changes • Hypersensitivity response • Bronchoconstriction • May become chronic with irreversible changes Presentation • • • • • Bronchospasm Increased mucus secretion Dyspnea Wheezing Cough Consequences of CAL • ABG’s – Initially normal ABG followed by decreased PaO2 and O2 saturation – Increased PaCO2 with an increase in HCO3 to compensate • Compensated Respiratory Acidosis and Hypoxemia Polycythemia • Related to decreased PaO2 • What is the mechanism? Pulmonary Function Tests • What do you expect? TLC increased FEV1 decreased Cor Pulmonale COPD/CAL Pulmonary Vascular Bed Pulm Hypertension RV Failure Hypoxemia Polycythemia LV Failure Collaborative Management of CAL • Medical management – Maximize oxygenation, ventilation and perfusion • Surgical management – Bullectomy – Lung volume reduction surgery Drug Therapy • Bronchodilators – Sympathomimetics – Methylxanthines • • • • • • Anticholinergics Steroids Mast Cell Stabilizers Leukotriene Antagonists Expectorants Antibiotics Nursing Diagnoses • • • • • Impaired gas exchange Ineffective airway clearance Activity intolerance Anxiety Altered nutrition: less than body requirements Nursing Interventions • Maintain a patent airway • Safely administer oxygen • Use oxygen delivery systems appropriately • Accurately assess the patient’s breathing • Use positioning to improve oxygenation Teach the Patient: • • • • • • • Abdominal & Pursed lip breathing Controlled coughing Conservation of energy Prevent secondary infection Insure hydration Nutrition Therapeutic communication/relaxation Metered Dose Inhaler (MDI) Peak Flow Meter
