COPD

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1. COPD ( CHRONIC OBSTRUCTIVE PULMONARY DISEASE) MONIKA TIMBADIYA F.Y.M.SC. NURSING IKDRC

2. ANATOMY OF BRONCHI AND ALVEOLI

3. INTRODUCTION COPD is also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease (CORD). COPD is a slowly progressive respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma, or both.

4. DEFINITION COPD is a chronic lung disease characterized by chronic obstruction of lung airflow that interfere with normal breathing and is not fully reversible.

5. COPD may include diseases that cause airflow obstruction

6. In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual, which tend to clog them.

7. 1. CHRONIC BRONCHITIS

8. DEFINITION : Chronic bronchitis, a disease of airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. Chronic bronchitis is an ongoing, serious condition. It occurs if the lining of the bronchial tubes is constantly irritated and inflamed, causing long terms cough with mucus.

9. 2. EMPHYSEMA

10. Emphysema (from the Greek word for “inflation”) is a lung disease that involves damage to the air sacs (alveoli) in the lungs. Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli. As the alveoli are destroyed the alveolar surface area in contact with capillaries decreases. Causing dead spaces (no gas exchange takes place) leads to hypoxia .

11. In later stage: CO2 elimination is disturbed and increase in CO2 tension in arterial blood causing respiratory acidosis.

12. CAUSES AND RISK FACTORS

13. PATHOPHYSIOLOGY

14. Tobacco smoke & Air pollution Breakdown of elastin in connective tissue of lungs Continual bronchial irritation & inflammation Chronic bronchitis bronchial edema, hypersecretion of mucus, chronic cough, bronchospasm Emphysema destruction of alveolar septa, airway instability Airway obstruction, Air trapping, Dyspnea , Frequent infections Abnormal ventilation – perfusion ratio Hypoxemia & Hypoventilation, Cor pulmonale α 1 – antitrypsin deficiency

15. STAGES OF COPD

16. CLINICAL MANIFESTATION

17. ADVANCED COPD SYMPTOMS

18. DIAGNOSTIC EVALUATION

19. History and Physical Examination

20. Lung Function test: Spirometry : it measures lung function, specifically the amount and/or speed of air that can be inhaled and exhaled.

21. Chest x-ray or chest CT scan: Arterial blood gas analysis: Alpha-1- antitrypsin level

22. Pulse Oximetry : A less invasive method to measure oxygen levels in the blood is called pulse oximetry . A probe is placed around a fingertip to measure the percentages of oxygen saturation in the blood.

23. MANAGEMENT

24. MEDICAL MANAGEMENT Goal : To prevent further deterioration in lung function. To alleviate symptoms To improve performance of daily activities and quality of life

25. Pharmacological Smoking cessation using nicotine replacement therapies Bronchodilators and anti-inflammatory agents Mucolytic Antibiotics Immunization Treatment of Alpha-1-antitrypsin deficiency

26. Non-pharmacological 1. Nebulization

27. 2. Oxygen therapy

28. 3. Exercise Diaphragmatic breathing Pursed lip breathing

29. PULMONARY REHABILITATION The primary goal of rehabilitation is to restore patients to the highest level of independent function possible and to improve their quality of life. Breathing exercises and retraining exercise programs are used to improve functional status, and the patient is taught methods to alleviate symptoms.

30. LIFE STYLE CHANGES Clear airways- controlled coughing, drinking plenty of water. Exercise regularly. Eat healthy foods. Avoid smoke. Avoid exposure to fumes and dust. Pay attention to frequent heartburn. Follow up regularly.

31. SURGICAL MANAGEMENT 1.Bullectomy 2. lung volume reduction 3. Lung transplant

32. NURSING MANAGEMENT Assessment

33. Nursing diagnosis Ineffective airway clearance related to bronchoconstriction, increased mucus production, ineffective cough . Impaired gas exchange related to decreased ventilation, chronic pulmonary obstruction, abnormalities due to destruction of alveolar capillary membrane . Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction, and airway irritants.

34. Imbalanced nutrition: less than body requirements related to increased work of breathing, air swallowing, drug effects with resultant wasting of respiratory and skeletal muscles . Activity intolerance related to fatigue, inadequate oxygenation and dyspnea . Anxiety related to acute breathing difficulties and fear of suffocation

35. Intervention Encourage diaphragmatic and coughing techniques. Change patient’s position every 2 hourly. Teach the patient to maintain adequate hydration by drinking at least 8-10 glasses of fluid per day. Administer low flow oxygen therapy. Administer bronchodilators if ordered. Advise the client to eat small frequent meals that are high in protein and calories. Keep the environment free from pollution.