Chronic Obstructive Pulmonary Disease.pptx

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1. Chronic Obstructive Pulmonary Disease . Menu

2. Chronic Obstructive Pulmonary Disease Chronic Bronchitis Emphysema Management of Client with COPD Nursing Diagnoses Bronchiectasis Asthma Menu

3. Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. COPD may include diseases that cause airflow obstruction (e.g., emphysema, chronic bronchitis) , bronchiectasis, and asthma Menu Menu

4. Chronic Bronchitis Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. Bronchitis is narrowed and has impaired air flow due to multiple mechanisms: i nflammation, excess mucus production , And potential smooth muscle constriction (bronchospasm). Bronchiectasis: chronic dilation of a bronchus or bronchi. Emphysema: a disease of the airways characterized by destruction of the walls of over distended alveoli. Menu Menu

5. Emphysema In emphysema, impaired gas exchange (oxygen, carbon dioxide) results from destruction of the walls of over distended alveoli. “Emphysema” is a pathological term that describes an abnormal distention of the air spaces beyond the terminal bronchioles, with destruction of the walls of the alveoli. As the walls of the alveoli are destroyed (a process accelerated by recurrent infections) Impaired oxygen diffusion, which leads to hypoxemia. Menu Menu

6. Emphysema cont … In the later stages of the disease, carbon dioxide elimination is impaired, Resulting in increased carbon dioxide tension in arterial blood ( hypercapnia ) and causing respiratory acidosis . Thus, right-sided heart failure ( cor pulmonale ) is one of the complications of emphysema. Congestion, edema, distended neck veins, or pain in the region of the liver suggests the development of cardiac failure. Menu Menu

7. Clinical Manifestations COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Dyspnea may be severe and often interferes with the patient’s activities . Weight loss is common because dyspnea interferes with eating. Often the patient cannot participate in even mild exercise because of dyspnea . The patient with COPD is at risk for respiratory infections, which in turn increase the risk for acute and chronic respiratory failure. In COPD patients, chronic hyperinflation leads to the “barrel chest ”, This results from fixation of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity. Menu Menu

8. Management of Client with COPD For patients with chronic obstructive pulmonary disease (COPD), physical activity is an important part of their quality of life. Pharmacologic Therapy Bronchodilators relieve bronchospasm and reduce airway obstruction. Corticosteroids. Inhaled and systemic corticosteroids (oral or intravenous) may also be used in COPD but are used more frequently Oxygen therapy can be administered to prevent acute dyspnea. Menu Menu

9. Pulmonary Rehabilitation Pulmonary rehabilitation for patients with COPD is well established and widely accepted as a means to alleviate symptoms Nursing Process for patient with COPD Assessment Assessment involves obtaining information about current symptoms as well as previous disease manifestations. Menu Menu

10. Nursing Diagnoses Based on the assessment data, the patient’s major nursing diagnoses may include the following: Ineffective airway clearance related to broncho constriction, increased mucus production, and ineffective cough. Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction, and airway irritants Activity intolerance due to fatigue, ineffective breathing patterns, and hypoxemia Ineffective coping related to reduced socialization, anxiety, depression, and the inability to work Menu Menu

11. Potential Complications Based on the assessment data, potential complications that may develop include: Respiratory insufficiency or failure Atelectasis Pulmonary infection Pneumothorax Menu Menu

12. Goal of Nursing Process The major goals for the patient may include: improve gas exchange, airway clearance, Improve breathing pattern Improve activity tolerance, maximal self-management, Improve coping ability, adherence to the therapeutic program and home care, and absence of complications . Menu Menu

13. Nursing Interventions The nurse should educate the patient regarding the hazards of smoking and cessation strategies and provide, counseling. Education is focused on rehabilitative therapies to promote independence in executing activities of daily living. The nurse instructs the patient to avoid extremes of heat and cold. Heat increases the body temperature, thereby raising oxygen requirements. Cold tends to promote broncho spasm. Air pollutants such as fumes, smoke, initiate bronchospasm. High altitudes aggravate hypoxemia. The nurse monitors pulse oximetry values to assess the patient’s need for oxygen and administers supplemental oxygen as prescribed. Menu Menu

14. Expected Patient Outcomes Demonstrates knowledge of hazards of smoking Demonstrates improved gas exchange Shows no signs of restlessness Has stable pulse oximetry Achieves maximal airway clearance Stops smoking Maintains adequate hydration Knows signs of early infection and is aware of how and when to report them if they occur Improves breathing pattern Practices and uses pursed-lip and diaphragmatic breathing Menu Menu

15. Bronchiectasis Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Cause: Airway obstruction Diffuse airway injury Pulmonary infections and obstruction of the bronchus Genetic disorders such as cystic fibrosis A person may be predisposed to bronchiectasis as a result of recurrent respiratory infections. Menu Menu

16. Clinical Manifestations Symptoms of bronchiectasis include: Chronic cough and the production of purulent sputum. Hemoptysis. Clubbing of the fingers because of respiratory insufficiency. Repeated episodes of pulmonary infection Assessment and Diagnostic Findings A definite sign is offered by the prolonged history of productive cough. Sputum consistently negative for tubercle bacilli. The diagnosis is A computed tomography (CT) scan, which demonstrates presence of bronchial dilation. Menu Menu

17. Medical Management Postural drainage is part of all treatment plans because draining the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection. Chest physiotherapy , including percussion and postural drainage, is important in secretion management. Infection is controlled with antimicrobial therapy based on the results of sensitivity tests. Menu Menu

18. Asthma Asthma is a chronic inflammatory disease of the airways. Predisposing factor for asthma. Exposure to airway irritants or allergens Symptoms Wheezing Cough Dyspnea Chest tightness Menu Menu

19. Complications Complications of asthma may include Status asthmaticus Respiratory failure Pneumonia Atelectasis . Menu Menu

20. Medical Management PHARMACOLOGIC THERAPY Corticosteroids e.g. prednisolone Aminophylline Theophylline Adrenaline Menu Menu