chronic obstructive pulmonary disease (copd) 9.18...title student copy 9.18.19 created date...

Chronic Obstructive Pulmonary Disease (COPD) 9.18.19

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

COPD Description

• Airflow limitation not fully reversible• progressive• Abnormal inflammatory response of lungs

• Includes• Chronic bronchitis• Emphysema


COPDEtiology

• Risk factors• Cigarette smoking•Occupational chemicals and dust• Air pollution• Infection •Heredity• Aging


COPDPathophysiology

•Defining features• Irreversible airflow limitations during forced

exhalation due to loss of elastic recoil• Airflow obstruction due to mucous hypersecretion,

mucosal edema, and bronchospasm


COPDPathophysiology


COPDClinical Manifestations

•Develops slowly•Diagnosis • Cough*• Sputum production•Dyspnea• Exposure to risk factors



•Dyspnea• exertion (early) stages/ rest (late)• Chest breathing• accessory and intercostal muscles• Inefficient breathing

• Chest tightness with activity



• underweight with adequate caloric intake• Chronic fatigue

•What physical finding will you find on exam?


Case Study

•G.S., a 77-year-old man at the hospital• shortness of breath•morning cough• swelling in his lower extremities.• difficulty breathing when he walks short

distances ie. bathroom.


Case Study

•G.S. subjective c/o:• “ sleeps in a recliner to make it easier to breathe”• “feels shoes are tight at the end of the day”

•He is placed on oxygen at 2 liters/minute via nasal cannula.


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Case Study• Dx: mild to moderate COPD• Hx: smoked a pack of cigarettes/day for 30 years. • heart disease and GERD.

Discuss questions:•How does his history contribute to his diagnosis?•Why does he experience swollen ankles?•What other complications is he at risk for?



COPDCor Pulmonale

•Hypertrophy of right side of heart• Result of pulmonary hypertension• Late manifestation • Eventually causes right-sided heart failure


Pathophysiology of Cor Pulmonale


COPDCor Pulmonale

• Dyspnea• Distended neck veins• Hepatomegaly with right upper quadrant tenderness• Peripheral edema•Weight gain


COPDCor Pulmonale

• Diagnostic studies• ECG• Chest x-ray• Right-sided cardiac catheterization• Echocardiogram• BNP levels


COPD Exacerbations

• Signaled by change in usual•Dyspnea• Cough• Sputum


COPDExacerbations

• poorer outcomes• Primary causes• Bacterial and viral infections

• Signs of severity•Use of accessory muscles• Central cyanosis


Case Study• G.S. shares that he has experienced “attacks” like

this in the past year, but this one was a bit worse. • He states that he and his wife had visited their

daughter and her 3 kids who were sick with colds.

•What is the likely cause of this exacerbation?•What would you anticipate in regard to treatment?•What is G.S. at risk for with exacerbation?



COPD Exacerbations

• Treatment• Short-acting bronchodilators• Corticosteroids• Antibiotics• Supplemental oxygen therapy


COPDAcute Respiratory Failure

• Caused by• Exacerbations•Discontinuing bronchodilator or corticosteroid

medication•Overuse of sedatives, benzodiazepines, and opioids• Surgery or severe, painful illness involving chest or

abdomen


COPDDepression and Anxiety

• experience many losses.• If patient becomes anxious because of dyspnea, teach

pursed lip breathing.


COPDDiagnostic Studies

•Diagnosis confirmed by spirometry• Reduced FEV1/FVC ratio• Increased residual volume



• Chest x-ray• History and physical• COPD Assessment Test (CAT)•Modified Medical Research Council (mMRC) Dyspnea

Scale• 6-minute walk test to determine O2 desaturation in the

blood with exercise• BODE index



• ABG typical findings in later stages• Low PaO2•↑ PaCO2•↓ pH•↑ Bicarbonate level found in late stages of COPD


Case Study

• G.S.’s arterial blood gases show a slight ↓ PaO2 and ↑ PaCO2, and his chest x-ray shows flattening of his diaphragm.•O2 saturation is 88%.•His FEV1/FVC is 65%, and he states he is having difficulty

completing ADLs without frequent rest periods.

•What interventions would be of benefit to G.S. at this time?



COPDCollaborative Care• Global Initiative for Chronic Obstructive Lung

Disease (GOLD)• American College of Physicians clinical guidelines

• Smoking cessation• Biggest impact in risk reduction• Accelerated decline in pulmonary function

slows to almost nonsmoking levels.


Case Study

• G.S. is given a short-acting bronchodilator via nebulizer.• He will also be given a SABA inhaler and an ICS for home use.• He is started on azithromycin (Zithromax).

•Why was a nebulizer used in the hospital?•What is the rationale for the SABA?•How should he use his ICS?•Will G.S. need oxygen for home use?



COPDCollaborative Care

•O2 therapy is used to• Keep O2 saturation > 90% during rest, sleep, and

exertion, or• PaO2 greater than 60 mm Hg.



• Long-term O2 therapy improves• Survival• Exercise capacity• Cognitive performance• Sleep in hypoxemic patients



•O2 delivery systems: high- or low-flow.• Low-flow most common- mixed with room air, and

delivery is less precise than high-flow.•High-flow fixed concentration• Venturi mask•Humidification



• Complications of oxygen therapy• Combustion • CO2 narcosis•O2 toxicity• Absorption atelectasis• Infection



• Long-term O2 therapy (LTOT) at home improves• Prognosis•Mental acuity• Exercise intolerance



• Respiratory and physical therapy• Breathing retraining• Effective coughing• Chest physiotherapy• Percussion• Vibration• Postural drainage



• Respiratory and physical therapy• Airway clearance devices•High-frequency chest wall oscillation• The Vest


Case Study

• G.S. is going to be discharged to home. • He is given an Acapella device to assist him with expulsion

of mucus. • His wife is present, and you begin to teach them about

home care.

•What will your teaching plan include?



COPDCollaborative Care• Surgical therapy• Lung volume reduction surgery

• Bullectomy

• Lung transplantation• Single lung—Most common because of donor

shortages• Prolongs life• Improves functional capacity• Enhances quality of life



•Minimally invasive treatment• Airway bypass• Bronchoscopic procedure• Used to reduce hyperinflation


Case Study

• G.S. appears fatigued and has difficulty answering the many questions he is asked. • His wife expresses concern that he has not been sleeping

well.

•What areas could be addressed with G.S. in regard to health promotion?

• How can his wife and family help?



Case Study

• G.S. comes into the clinic in one week for follow-up. • He is breathing much easier and states that he is able to

perform ADLs with less distress.

• He and his wife ask about how to prevent further breathing difficulties?



The nurse reviews the arterial blood gases of a patient. Which result would indicate the patient has later stage COPD?

a. pH 7.32, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/Lb. pH 7.30, PaCO2 45 mm Hg, PaO2 55 mm Hg, HCO3 18 mEq/Lc. pH 7.40, PaCO2 40 mm Hg, PaO2 70 mm Hg, HCO3 25 mEq/Ld. pH 7.52, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 35 mEq/L

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Audience Response Question


chronic obstructive pulmonary disease (copd) 9.18...title student copy 9.18.19 created date...

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