copd ppt
TRANSCRIPT
Presented By: Fretzie Anne G. Gomez, CMT, RN
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD)
G OLD
G OLD
lobal Initiative for
Chronic
bstructive
ung
isease
lobal Initiative for
Chronic
bstructive
ung
isease
United StatesUnited States
United Kingdom
ArgentinaArgentina
AustraliaAustralia
AustriaCanadaCanada
Chile
Belgium
ChinaChina
DenmarkDenmarkColumbiaColumbia
EgyptEgypt
GreeceItalyItaly SyriaSyria
Hong Kong ROC
Iceland
IndiaIndia
KoreaKorea
UruguayUruguay
MoldovaMoldova
NepalNepal
Macedonia
Malta
New Zealand
PolandPoland NorwayNorway
Portugal
GeorgiaGeorgia
Romania
SingaporeSlovakia
SwedenSweden
ThailandThailand
SwitzerlandSwitzerland
UkraineUkraine
United Arab EmiratesUnited Arab Emirates
VenezuelaVenezuela
Peru Yugoslavia
France
Mexico
Turkey Czech Republic
Pakistan
GOLD National Leaders
PhilippinesTeresita S. deGuia, MD
Philippine Heart Center
Quezon City, PH
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
- COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. (GOLD)
- COPD is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.(World Health Organization).
COPD is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.(National Heart Lung and Blood Institute)
The airflow limitation is usually progressive & is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
COPD is the 4th leading cause of death, and the 2nd cause of disability in the U.S. and yet, COPD is under diagnosed and under-treated:
About 24 million U.S adults have evidence of impaired lung function.
12 million people have been diagnosed with COPD.
5.8 million COPD patients are UNTREATED.
The COPD death rate among women is increasing.
REFERENCES GOLD2008 and American Thoracic Society
Epidemiology of COPD
Chronic Bronchitis- is the chronic inflammation of
bronchi characterized by productive cough that lasts 3 months a year for 2 consecutive years.
Emphysema- is a long-term, progressive disease
of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung).
COPD includes:
Stages of COPD:
STAGE I (mild)-Often minimal shortness of breath
with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal
- FEV > 80% of predicted
STAGE II (moderate)-Often moderate or severe shortness
of breath on exertion, with or without cough, sputum or dyspnea. Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation
- FEV 50-80% of predicted
STAGE III (severe)-more severe shortness of breath,
with or without cough, sputum or dyspnea - often with repeated exacerbations which usually impact quality of life, reduced exercise capacity, fatigue
- FEV 30 – 50% of predicted
STAGE IV (very severe)-appreciably impaired quality of life
due to shortness of breath - possible exacerbations which may even be life threatening at times
-FEV Less than 30% of predicted -- or less than 50% with chronic respiratory failure
Anatomy & Physiology of Respiratory System
Parts of the Resp. System:
1.Nasal Cavity2.Larynx3.Pharynx4.Trachea5.Bronchi6.Bronchioles7.Alveoli8.Lungs
Human Respiratory System
1. Nasal cavity: Air enters nostrils, is filtered by hairs, warmed, humidified, and sampled for odors as it flows through a maze of spaces.
2. Pharynx (Throat): Intersection where pathway for air and food cross. Most of the time, the pathway for air is open, except when we swallow.
3. Larynx (Voice Box): Reinforced with cartilage. Contains vocal cords, which allow us to make sounds by voluntarily tensing muscles.
4. Trachea (Windpipe): Rings of cartilage maintain shape of trachea, to prevent it from closing. Forks into two bronchi.
5. Bronchi (Sing. Bronchus): Each bronchus leads into a lung and branches into smaller and smaller bronchioles, resembling an inverted tree.
6. Bronchioles: Fine tubes that allow passage of air. Muscle layer constricts bronchioles. Epithelium of bronchioles is covered with cilia and mucus.
Mucus traps dust and other particles.
Ciliary Escalator: Cilia beat upwards and remove trapped particles from lower respiratory airways. Rate about 1 to 3 cm per hour.
Mechanics of Breathing
PathogenesisSMOKIN
GEnvironmental & Occupational
Exposure
Childhood Respiratory infectionsGenetic
susceptibility
CD8+ Lymphocy
te
Alveolar Macropha
geNeutrophil
Protease
Airway Inflammation
and Remodeling
Airflow Limitation
Tissue Destruction
Protease Inhibitor
Changes in Lung Parenchyma in COPD
Alveolar wall destruction
Loss of elasticity
Destruction of pulmonarycapillary bed
↑ Inflammatory cells macrophages, CD8+ lymphocytes
Risk Factors for COPD-Genes
-Exposure to particlesTobacco smokingOccupational dustIndoor air pollutionOutdoor air pollution- Gender- Age- Respiratory infections
-Socioeconomic factorsPovertyCongested Living spaceLack of EducationUse of Biomass fuels,
wood stovesInner City population
has more prevalenceStress of environment
Lack of funds for treatment in exacerbations
Malnourishment
Socioeconomic statusAging
Population
Genes
CHRONIC BRONCHITIS
NicotinePATHOPHYSIOLOGY OF CHRONIC BRONCHITIS
Edema of the bronchial wall
Contraction of the smooth
muscle of the bronchioles
Hypersecretion of the bronchial mucus gland
Airway obstruction
Increase airway resistance
Impairment of ventilation
Impairment of gas exchange
Hypoxia
Cyanosis“Blue
bloater”
Long-term Cough-accompanied by increased mucus
production
Shortness of breathWheezingFeverCyanosisChest pain
Manifestations:
EMPHYSEMA
Panlobular (panacinar)-destruction of respiratory bronchiole, alveolar
duct and alveolus.Centrilobular (centroacinar)-pathologic changes take place mainly in the
center of the secondary lobule.
Types of Emphysema:
PATHOPHYSIOLOGY OF EMPHYSEMASmoking
Stimulates alveolar macrophages
Release of protease and
elastase
Loss of the lung elastic recoil
Overdistention of ALVEOLI
Retention of CO2
Impaired ventilation
Hypoxemia, Hypercarbia
Increase in RR
Redness of skin
PINK PUFFER
DOB
CoughDyspneaChest painWheezingBarrel chestCold clammy skinDecreased metabolism - weakness -anorexia -weight loss
Manifestations:
Pulmonary function tests (PFTs)
They measure how much air lungs can hold and the flow of air in and out of lungs.
They can also measure the amount of gases exchanged across the membrane between alveolar wall and capillary membrane.
Diagnostic Exams:
is performed to evaluate the lungs, heart and chest wall.
is rarely useful for diagnosing chronic bronchitis, although they sometimes show mild scarring and thickened airway walls.
Shows increased in AP diameter, overinflation and presence of bullae.
Chest X-ray
Clear signs of COPD include the following:
Abnormally large amounts of air spaces in the lung.
A flattened diaphragm.A smaller heart; if heart failure is present,
however, the heart becomes enlarged and there may not be signs of overinflated lungs.
Exaggerated lung inflation in upper areas.Larger amounts of air in the lower lungs in
patients with A1AD-related emphysema.
These blood tests measure how the lungs transfer oxygen to bloodstream and how effectively they remove carbon dioxide.
Low oxygen (hypoxia) and high carbon dioxide (hypercapnia) levels often indicate chronic bronchitis, but not always emphysema. A blood gas analysis that shows very low oxygen levels is useful for determining which patients would benefit from oxygen therapy.
Arterial blood gases (ABG) analysis
This test involves use of a small device that attaches to the fingertip.
The oximeter measures the amount of oxygen in the blood differently from the way it's measured in blood gas analysis.
To help determine whether patient needs supplemental oxygen, the test may be performed at rest, during exercise and overnight.
Pulse Oximetry
Analysis of cells in sputum can help determine the cause of some lung problems.
Sputum examination
Computerized tomography (CT) scan A CT scan can detect emphysema sooner
than an X-ray can, but it can't assess the severity of emphysema as accurately as can a pulmonary function test.
Physicians will typically test for the protective enzyme alpha-1 antitrypsin in COPD patients who are nonsmokers and who develop emphysema in their 30s.
Test for alpha-1 antitrypsin deficiency
Carbon Monoxide Diffusing CapacityThe lung carbon monoxide diffusing
capacity (DLCO) test determines how effectively gases are exchanged between the blood and airways in the lungs. Patients should not eat or exercise before the test, and they should not have smoked for 24 hours.
Pulmonary Hypertension
COR Pulmonale
Malnutrition
Skeletal Muscle Dysfunction
Atelectasis
COMPLICATIONS:
Pharmacotherapy
-Expectorants (guaiafenesin) / Mucolytic (mucosolvan)
-Bronchodilators (Salbutamol, Theophylline, Terbutaline)
These drugs can help relieve coughing, shortness of breath and trouble breathing by opening constricted airways, but they're not as effective in treating emphysema as they are in treating asthma.
Medical Management
-SteroidsAdministered for anti-inflammatory effects.
(Solu-medrol, Beclomethasone).Although inhaled steroids have fewer side
effects than oral steroids do, prolonged use can weaken bones and increase the risk of high blood pressure, cataracts and diabetes.
-AntibioticsOnly to treat infectious exacerbations of
COPD
Non-Pharmacologic Treatment
Rehabilitation: All COPD patients benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue.
Oxygen Therapy: The long-term administration of oxygen (> 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival.
Diet- High calorie, High Protein and low
Carbohydrate
Bronchial Hygiene Measures-Steam Inhalation-Aerosol Inhalation-Medimist inhalation
Chest Physiotherapy-Percussion-Vibration-Postural drainage
Lung transplant-Replaces a sick lung with a healthy lung from a
person who has just died.
Lung Volume Reduction Surgery-Removes part of one or both lungs, making
room for the rest of the lung to work better. It is used only for severe emphysema.
Bullectomy-Removes the part of the lung that has been
damaged by the formation of large, air-filled sacs called bullae. This surgery is rarely done.
Surgery in COPD
Ineffective airway clearance r/t excessive, thickened mucus production.
Ineffective breathing pattern r/t shortness of breath, mucus, bronchoconstriction, and airway irritants.
Impaired gas exchange r/t alveolar and capillary changes and ventilation-perfusion imbalance.
Activity intolerance r/t hypoxemia.Knowledge deficit regarding disease
process and prognosis related to less information.
Nursing Management
Plan: Patient will maintain airway patency.
Interventions:1. Adequately hydrate the patient.2. Monitor respirations and breath
sounds.3. Teach and encourage the use of
diaphragmatic breathing and coughing exercise.
4. Elevate head of the bed/ position every 2 hours and PRN.
5. If indicated, perform postural drainage.
Ineffective airway clearance r/t excessive, thickened mucus production.
Plan: Patient will establish effective respiratory pattern AEB absence of cyanosis and other signs of hypoxia.
Intervention:1. Teach patient diaphragmatic and pursed-lip
breathing.2. Encourage alternating activity with rest
periods.3. Elevate head of the bed or have the client
sit up in the chair, as appropriate.4. Assist the client in the use of relaxation
techniques.5. Administer oxygen as indicated in a lower
concentration.
Ineffective breathing pattern r/t shortness of breath, mucus, and bronchoconstriction.
Plan: Patient will demonstrate improved ventilation and adequate oxygenation of tissues AEB ABG within normal limits.
Interventions:1. Position client in the semi-Fowler’s position. 2. Monitor client’s oxygen saturation
continuously by pulse oximetry. 3. Maintain adequate intake and output for
mobilization of secretions.4. Encourage adequate rest and limit activity.5. Keep environment allergen-free or pollutant-
free.
Impaired gas exchange r/t alveolar and capillary changes and ventilation-perfusion imbalance.
Plan: Patient will report measurable increase in activity tolerance.
Interventions:1. Plan care to carefully balance rest periods with
activities.2. Promote comfort measures and provide relief of
pain.3. Assist patient in learning appropriate safety
measures.4. Evaluate client’s actual and perceived limitations
in light of usual status.5. Encourage use of relaxation techniques.
Activity intolerance r/t imbalance between oxygen supply and demand.
Plan: Patient will participate in the learning process.
Interventions:1. Ascertain level of knowledge including
anticipatory needs.2. Provide positive reinforcement.3. Determine client’s ability/ readiness to
learning.4. Help patient identify or develop short and long
term goals.5. Provide information relevant only to the
situation.
Knowledge deficit regarding disease process and prognosis related to less information.
Breathing Exercises-Diaphragmatic breathing-Pursed-lip breathing-Deep breathing exercise
Smoking cessation
Nutritional counselling
Health Education