Chronic obstructive pulmonary disorder (copd)

At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education

1. Chronic Obstructive Pulmonary Disorder (COPD) Jamilah saad AlQahtani CNS,MSN,NS,RGN,BSN, OR Specialist 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 1

2. Objectives At the end of this lecture student able to : Define COPD List causes of COPD List risk factors of COPD List signs and symptoms of COPD List diagnostic measures Describe treatment of COPD Identify complications of COPD Use nursing process Discuss relevant patient / family education . 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 2

3. Outlines Introduction Definition Causes Pathophysiology Signs & symptoms Treatment Nursing management Patient Education 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 3

4. Introduction COPD is a set of lung diseases that limit air flow and is not fully reversible . COPD patients report they are “hungry” for air Usually progressive and is associated with inflammation of the lungs as they respond to noxious particles or gases Potentially preventable with proper precautions and avoidance of precipitating factors Symptomatic treatment is available 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 4

5. Definition Chronic obstructive pulmonary disease (COPD) is a group of conditions causing the chronic or recurrent obstruction of airflow . It can result from the combination of symptoms associated with: Chronic bronchitis Emphysema Asthma 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 5

6. Epidemiology 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 6 About 13.9% of the U.S. adult population (25+ years) have been diagnosed with COPD An estimated 15-19% of COPD cases are work-related 24 million other adults have evidence of troubled breathing, indicating COPD is under diagnosed by up to 60% * Braman , S. Update on the ATS Guidelines for COPD. Medscape Pulmonary Medicine. 2005;9(1):1. **CDC programs in Brief– Workplace Health and Safety-Work-related Lung Diseases. www.cdc.gov/programs/workpl18.htm ***COPD Fact Sheet. Oct 2003. www/lungusa.org

7. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 7 Gender COPD occurrence is higher among women in all age groups except the two highest age groups (75–84 and 85 and over), for which the difference was not statistically significant (CDC, 2011). The increased level of smoking by women over the past 30 years is causing the women’s death rate from COPD to rise. Today, more American women than men die from COPD, and more than 170,000 women die each year from smoking-related diseases (ALA, 2010) . Women were diagnosed with COPD with lower pack-years, fewer comorbidities, and less bronchial obstruction, but worse diffusion capacity impairment ( Laitenen , 2009). http://www.nursingceu.com/courses/405/index_cm.html#prognosis

8. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 8 Race The prevalence of COPD follows the history of the level of smoking in a population. In the United States, higher rates of COPD are found among those who have had the highest levels of smoking: white people, blue-collar workers, and people with less formal education. More Caucasians in the United States die from COPD than people of other races (CDC, 2009b). Mortality Rates COPD is the fourth leading cause of death in the United States (ALA, 2010). Approximately one half of COPD patients die within 10 years of their initial diagnosis (ALA, 2011). http://www.nursingceu.com/courses/405/index_cm.html#prognosis

9. Age of Onset COPD is most common in older people because symptomatic COPD usually takes more than 20 pack-years of smoking to develop. The typical COPD patient has a smoking history of more than 40 pack-years. Today, 21% of adult Americans are smokers, and 1 of 5 high school students has smoked in the last month (CDC, 2011). 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 9

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13. In KSA 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 13

14. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 14 ANATOMY AND PHYSIOLOGY

15. Breathing cycle 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 15

16. Etiology 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 16 Three Major Causes of COPD

17. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 17 Chronic Bronchitis is characterized by Chronic inflammation and excess mucus production Presence of chronic productive cough Emphysema is characterized by Damage to the small, sac-like units of the lung that deliver oxygen into the lung and remove the carbon dioxide Chronic cough *Source: Braman , S. Update on the ATS Guidelines for COPD. Medscape Pulmonary Medicine. 2005;9(1):1. Cont ’

18. Cont ’ Asthma : is a chronic inflammatory disorder of airways. The chronic inflammatory disorder leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in early morning. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 18

19. Pathophysiology 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 19

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21. Prognosis The progressive destruction of lung tissue leads to the emphysematous form of COPD, which is characterized by: Destruction of alveoli Loss of lung elasticity Loss of lung supporting tissue The collapse of small airways 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 21

22. IMPORTANT "We have no cure, no treatments that will stop progression or reverse the condition," says James Kiley, PhD, director of the lung-disease division of the National Institutes of Health. "But we can do better by getting to people early." 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 22

23. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 23 Contributing Factors Associated With COPD History of smoking Occupation (certain occupations have increased risk for lung disease related to environmental work conditions) History of lung disease Allergies Recent pulmonary infection

24. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 24 Risk Factors

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27. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 27 Signs and Symptoms COPD Conditions Chronic bronchitis Dyspnea Cyanosis Prolonged expiration Scattered crackles, rhonchi and wheezing Cardiac dysrhythmias Increased mucus production Productive cough Increased anterior-posterior diameter Peripheral edema Normal respiratory rate

28. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 28 Signs and Symptoms COPD Conditions Emphysema Dyspnea Barrel chest Use of accessory muscles Increased AP diameter of chest Decreased BS with expiratory wheezes Patient may look pink and puffy Tachypnea Leans forward while sitting Breathing through pursed lips

29. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 29 Signs and Symptoms COPD Conditions Asthma Prolonged expiratory time Pursed lips Wheezing with decreased breath sounds Cough May have upper airway rhinitis, sinusitis or nasal polyps Dyspnea Decreased PEFR Accessory muscle use Increased work of breathing Decreased oxygen saturation

30. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 30 Normal versus Diseased Bronchi

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32. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 32 Asthma

33. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 33 Other signs of COPD can include: weight loss tiredness and fatigue swollen ankles

34. COPD Diagnostic tests 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 34 S ymptoms P hysical examination S ample of sputum C hest x-ray H igh-resolution CT (HRCT scan) P ulmonary function test ( spirometery ) A rterial blood gases test P ulse oximeter

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36. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 36 PFT- pulmonary function test CXR - positive findings include hyperinflation of the lung, cardiac enlargement, flattened diaphragm, congested lung fields PEFR (peak expiratory flow rate) - will measure the expiratory ability and help assess condition improvement after treatment. Pulse oximetry ABG - decreased pao 2 ; Increased pco 2 Diagnostic Procedures

37. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 37 Diagnostic Procedures CBC with differential - increased WBC indicative of infection; eosinophilia indicative of asthma Sputum cultures - specifically identify infectious agent Enzymes - may show decreased level of Alpha-1antitrypsin deficiency

38. CLASSIFICATION OF COPD According to the Global Initiative for Obstructive Lung Disease (GOLD), the severity of COPD is divided into four grades (formerly called stages) classified by spirometric measurement: GOLD 1, Mild; GOLD 2, Moderate: GOLD 3, Severe; and GOLD IV, Very Severe . 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 38

39. Treatment Medical : Surgical : Prolactive 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 39

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41. Medical Treatment 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 41 Give antibiotics to treat infection Give bronchodilators to relieve bronchospasm, reduce airway obstruction, mucosal edema and liquefy secretions. Chest physiotherapy and postural drainage to improve pulmonary ventilation. Proper hydration helps to cough up secretions or tracheal suctioning when the patient is unable to cough. Steroid therapy if the patient fails to respond to more conservative treatment.

42. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 42 Medical Treatment ( cont … ) S top smoking O xygenation with low concentration during the acute episodes In asthma adrenaline (epinephrine) SC if the bronchospasm not relieved. A minophylins IV if the above treatment does not help. IV corticosteroids for patients with chronic asthma or frequent attack. S edative or tranquilizers to calm the patient. I ncrease fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation. I ntubations and mechanical ventilation if there is respiratory failure .

43. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 43 Complications A prompt, accurate assessment to identify signs and symptoms of COPD , combined with the appropriate treatment , can help prevent serious complications associated with this condition .

44. Complications Chronic respiratory acidosis which may be a sign of respiratory failure , with dangerously low blood oxygen levels. Excessive respiratory acidosis may lead to confusion, lethargy, or poor organ function -- in extreme cases, low blood pressure and shock may result . 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 44

45. Complications Respiratory insufficiency and failure are major life threatening complications of COPD. Pneumonia, chronic atelectasis , pneumothorax, and pulmonary arterial hypertension( corpulmonary ) 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 45

46. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 46 What medications are used to prevent complications? Annual flu vaccine Reduces risk of flu and its complications Pneumonia vaccine Reduces risk of common cause of pneumonia

47. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 47 Nursing Care Plan

48. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 48 Nursing Assessment Nasal flaring Cyanosis Dyspnea Decreased respiratory effort Decreased LOC Accessory muscle use Decreased breath sounds Decreased oxygen saturation

49. Nursing Diagnosis 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 49

50. Actual problems Acute pain related to coughing/respiratory distress evidence by tachycardia and increased BP BP 158/98 mmhg ,HR 107bpm. Ineffective breathing pattern related to inadequate chest expansion evidence by increase respiratory rateRR32bpm. Ineffective airway clearance related to increased mucus production in bronchial tubes evidence by productive cough with sputum, wheezing, alteration of ABG and change in breathing pattern. Impaired gas exchange related to increased upper and lower airway resistance caused by over production of secretion along bronchial tubes evidence by Po2 52mmhg with room air and PCo2 54 mmhg , BP 158/98 mmhg ,HR 107bpm, RR 32bpm, general weakness, Decrease cardiac output related to disease process evidence by BP 158/98 mmhg ,HR 107bpm, RR 32bpm Hyperthermia /infection related to a gram-positive organism, streptococcous pneumonia evidence by temp 38,9C and WBCs 20,000mm3 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 50

51. Potential problems Activity intolerance related to increase breathing work. Imbalance nutrition: less than body requirements related to poor appetite resulting from fever, dyspnea and fatigue /increases metabolic need caused by increased work of breathing . Anxiety related change in health status. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 51

52. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 52 Nursing Interventions Allow the patient to assume a position of comfort for easiest breathing. Begin O 2 therapy based on the patient's condition. Continue to monitor oxygen delivery, especially if the patient is showing signs of chronic bronchitis. High-flow oxygen could cause the opposite effect desired, making the patient lose the drive to breathe. A Venturi mask is the most precise method of delivering exact amounts of oxygen.

53. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 53 Nursing Interventions Continuously monitor vital signs, including oxygen saturation. Prepare for more aggressive measures in case the patient's condition worsens. Greater ventilatory support may become necessary. Continuously monitor for cardiac dysrhythmias.

54. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 54 Nursing Interventions If the patient is in respiratory failure, begin high-flow oxygen delivery regardless of history. Obtain IV access. Fluids are frequently given to help liquefy secretions.

55. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 55 Nursing Interventions Commonly ordered medications include: 1. Nebulized inhalers - medication is inhaled by the patient. 2. Bronchodilator - stimulates b-receptors for bronchodilation. Medication is inhaled through the mouth. The dosage differs, based on the type of bronchodilator used as well as the patient's age and acute or chronic condition.

56. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 56 Nursing Interventions 3. Corticosteroids - decrease inflammation of epithelial cells in asthma. 4. Antibiotics may also be given if an infectious process is suspected. Administer as ordered by the physician, and discuss administration with the patient to ensure that antibiotic therapy is continued when the patient is released, if needed.

57. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 57 Patient & Family Education Call your health care provider if you have symptoms of lung disease. Call 997 or get to an emergency room if you suspect you have severe respiratory acidosis -- this is a MEDICAL EMERGENCY.

58. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 58 Patient & Family Education Not smoking -- or quitting if you smoke -- can prevent the development of many severe lung diseases that can lead to respiratory acidosis. Obese patients may prevent obesity hypoventilation syndrome by losing weight

59. SUMMARY That COPD is an irreversible lung disease, speaks loudly for the importance of COPD treatment in slowing down the progression of the disease and improving quality of life. While many medications are available to treat COPD, no drug has demonstrated effectiveness in halting the insidious progression of the disease. Rather, the goal of drug therapy at this time is to maintain control of symptoms and prevent  COPD exacerbation. 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 59

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61. REFFERRENCES American Lung Association. Breathing hazards at work, Workplace exposures can generate breathing hazards, accessed 11/02/06 American Lung Association. Chronic obstructive pulmonary disease (COPD) Fact Sheet, 2003 www.lungusa.org Centers for Disease Control, DHHS, CDC Programs in Brief-Workplace Health and Safety-Work-Related Lung Disease, 2005 www.cdc.gov/programs/workpl18.htm National Heart, Lung, and Blood Institute, NIH. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease Executive Summary, Updated 2003 National Heart, Lung, and Blood Institute, NIH. COPD-Key points and How is COPD treated? January, 2006 http://www.nhlbi.nih.gov/health http://www.nursingceu.com/courses/405/index_cm.html#prognosis 6/1/2018 COPD, DONE BY: JAMILAH SAAD Al QAHTANI 61

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