COPD by Dr.Raafat AL-Awadhi nursing .pptx

Nursing College

1. by : Dr. Raafat AL-Awadhi Chronic obstructive pulmonary disease (COPD) Medical and Surgical Nursing

2. Definition: Chronic obstructive pulmonary disease is a preventable and treatable disease characterised by chronic dyspnea with persistent expiratory airflow limitation that is usually progressive, and irreversible disease . Introduction

3. Classification 2- Emphysema : A pathologic diagnosis: permanent enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar walls. People with emphysema are also called “pink puffers”. 1- Chronic bronchitis A clinical diagnosis: chronic cough productive of sputum for at least 3 months per year for at least 2 consecutive years. bronchitis is also termed as “blue bloaters”. The two often coexist . Pure emphysema or pure chronic bronchitis is rare. (see at figure1) (figure1)

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5. blue bloaters pink puffers figure1

6. Tobacco smoke (indicated in almost 90% of COPD cases) . α1-Antitrypsin deficiency . Environmental factors (e.g., second-hand smoke) . Chronic asthma . Indoor air pollution . Occupational exposures, such as coal dust, silica . Lung growth: childhood infections or maternal smoking . Infections:HIV infection is associated with emphysema . Risk Factors and Causes

7. Chronic cough. Sputum production . Dyspnea (on exertion or at rest, depending on severity) . SIGN AND SYMPTOMS SYMPTOMS SIGN Tachypnea, tachycardia Cyanosis Use of accessory respiratory muscles .

8. Prolonged forced expiratory time on physical examination During auscultation, end-expiratory wheezes on forced expiration, decreased breath sounds, and/or inspiratory crackles Hyperresonance on percussion   Barrel chest Flushed face . Cont.. (see at figure2) .

9. figure2

10. Pulmonary function testing ( spirometry ) a. This is the definitive diagnostic test. b. Obstruction is evident based on the following: Decreased FEV1 and decreased FEV1/FVC ratio If FEV1 is reduced to 70% of predicted value, mild disease is suggested. If FEV1 is reduced to 50% or less of predicted value, severe disease is present. Values in between indicate moderate disease Diagnostic evaluation

11. Chest X-ray :   Low sensitivity for diagnosing COPD; only severe, advanced emphysema will show the typical changes, which include: Hyperinflation, flattened diaphragm Arterial blood gases (ABGs):  Determines degree and severity of disease process, e.g., chronic pCO2 retention and decreased pO2 . (see at figure3) . Cont..

12. figure3

13. Complete blood count (CBC) and differential:  Increased hemoglobin (advanced emphysema),. Screening for alpha1-antitrypsin deficiency. Sputum culture: Determines presence of infection Cytologic examination: for malignancy Electrocardiogram (ECG):,  CT scan. may help in the differential diagnosis. Cont..

14. Acute exacerbations —most common causes are infection .   Acute Respiratory Failure . Spontaneous Pneumothorax . Secondary polycythemia : compensatory response to chronic hypoxemia Pulmonary HTN and cor pulmonale —may occur in patients with severe, longstanding COPD who have chronic hypoxemia Complications

15. Smoking cessation: • The most important intervention • Disease progression slowed by cessation • prolongs the survival rate Inhaled anticholinergic drugs (ipratropium bromide): • Bronchodilatos • Slower onset of action than the β-agonists, but last longer Inhaled β2- agonists (e.g., albuterol): • bronchodilators • Use long-acting agents (e.g., salmeterol ) for patients requiring frequent use. MANAGEMENT

16. Combination of β- agonist albuterol with ipratropium bromide • More efficacious than either agent alone in bronchodilation Cont.. Corticosteroids: may be prescribed for patients to determine whether pulmonary function improves and symptoms decrease . Other medications include alpha1-antitrypsin augmentation therapy, antibiotic agents, mucolytic agents, antitussive agents, Oxygen therapy • Some patients need continuous oxygen, whereas others only require it during exertion or sleep. Theophylline (oral)—role is controversial • Only modestly effective and has more side effects than other bronchodilators.

17. Cont.. Vaccination: • Influenza vaccination annually for all patients. • Vaccination against Streptococcus pneumoniae every 5 to 6 years should be offered to patients with COPD over 65 years old, or under 65 who have severe disease . Pulmonary rehabilitation : • Education, exercise, physiotherapy: A major goal is to improve exercise tolerance. • Pulmonary rehabilitation improves functional status and quality of life .

18. 1.Bronchodilators (β2-agonist) alone or in combination with anticholinergics are first-line therapy 2.Systemic corticosteroids Acute COPD exacerbation A persistent increase in dyspnea and Increased sputum production and cough are common. Acute COPD exacerbation can lead to acute respiratory failure requiring hospitalization, and possibly mechanical ventilation; potentially fatal. Management: 3.Antibiotics (azithromycin or levofloxacin) 4.Supplemental oxygen is used to keep O2 saturation above 90%. 5.Intubation and mechanical ventilation may be required

19. Nursing intervention Regularly monitor vital signs and oxygen saturation ,ABG results , the severity of dyspnea and sputum color,odor and character . Elevate head of bed , assist patient to assume position to ease work of breathing Teach the client to use pursed-lip and diaphragmatic breathing techniques Perform chest physiotherapy . note use of accessory muscles , pursed lip breathing , inability to speak .

20. Teach the client to wash his or her hands after contact with potentially infectious material . Explain the patient about disease including cause , signs and symptoms , medication , procedures , prevention Explain need for adequate nutritional intake Explain client about the importance of self care Notify the physician if any sign of infections occurs . Administer bronchodilators and supplemental oxygen therapy if ordered Cont..

21. Thank you