COPD(chronic obstructive pulmonary disease) ppt slideshare

chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.

1. COPD (CHRONIC obstructive pulmonary DISEASE) Presented by: Sonam

2. COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) chronic obstructive lung disease (COLD), Chronic obstructive airway disease (COAD), chronic airflow limitation (CAL), and chronic obstructive respiratory disease (CORD).

3. introduction A pair of two commonly co-existing disease of the lungs in which the airways become narrowed. Leads to a limitation of the flow of air to and from the lungs causing shortness of breath. Is a preventable and treatable slowly progressive respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma, or both.

4. EPIDEMIOLOGY

5. CAUSES .

6. Chronic bronchitis Cough with expectoration for at least 3 months a year for more than 2 consecutive years and there is no other cause of expectoration.

7. . TYPES : Simple chronic bronchitis Chronic mucopurulent bronchitis Chronic bronchitis with obstruction/chronic asthmatic bronchitis

8. EMPHYSEMA Permanent & destructive enlargement of airspaces distal to the terminal bronchioles with out obvious fibrosis and with loss of normal architecture

9. . Types :

10. CLINICAL FEATURES

11. ASSESSMENT AND DIAGNOSTIC EVALUATION Health history Cold or flu or respiratory difficulty Pattern of symptom development Exertion increase the dyspnea Limits of the patients tolerance for exercise Smoke or spend time around others who smoke Exposed to dust, fumes, vapors, or air pollution

12. Contd … At what times during the day does the patient complain most of fatigue and shortness of breath Any discomfort or pain in any part of the body Exposed to risk factors (types, intensity, duration) Past medical history of respiratory diseases Family history of chronic obstructive pulmonary disease or other chronic respiratory diseases Eating and sleeping habits Impact of respiratory disease on quality of life

13. contd … Smoking history Occupational exposure The triggering events (e.g., Exertion, strong odors, dust, exposure to animals) History of exacerbations or previous hospitalizations for respiratory problems Comorbidities present Current medical treatments Available social and family support Potential for reducing risk factors (e.g., Smoking cessation)

14. PHYSICAL ASSESSMENT Notice the position the patient assume during the interview Vital signs especially respiratory rate and its depth and respiratory pattern Character of respirations? Even and without effort Can the patient complete a sentence without having to take a breath Contraction of the abdominal muscles during inspiration Use of accessory muscles of the shoulders and neck when breathing Patient take a long time to exhale (prolonged expiration) Central cyanosis evident

15. Contd … Neck veins engorged Peripheral edema Coughing Color, amount, and consistency of the sputum Clubbing of the fingers Types of breath sounds (i.e., Clear, diminished or distant, crackles, and wheezes) Sensory deficits Short- or long-term memory impairment Increasing stupor Apprehension

16. Diagnostic evaluation ABG analysis - to assess baseline oxygenation and gas exchange Screening of alpha 1 antitrypsin deficiency – done for patients with age less than 45 years and for those with family history of COPD CT scan - not done routinely, by may help in differential diagnosis Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV 1 to FVC PFT - to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression  

17. .

18. MEDICAL MANAGEMENT Risk reduction

19. Contd … 2) Pharmacological therapy For grade I – mild COPD – a short acting bronchodilator For grade II or III COPD – a short acting bronchodilator and regular treatment with one or more long acting bronchodilator For grade III or IV COPD (severe or very severe) – regular treatment with one or more bronchodilators and/or inhaled corticosteroids for repeated exacerbations .

20. Contd … Use of pressurized metered-dose inhaler ( pmdi ) Drugs include: Short acting beta agonist (salbutamol, albuterol, levabuterol ) and Long acting beta agonists ( salmetrol , formoterol, indacterol ), Muscuranic agonists(anticholinergics – ipratropium bromide) and Combination agents ( fenoterol and ipratropium). Corticosteroids

21. Contd … Other medications: alpha 1 antitrypsin augmentation therapy, antibiotic agents, mucolytic agents, antitussive agents, vasodilators. Vaccine: such as influenza vaccine can reduce serious morbidity and death in patients with COPD by approximately 50%. 3) Management of exacerbations : Roflumilast may be used to reduce the risk of exacerbations. It is a selective phosphodiesterase-4 (PDE4) inhibitor. 4) general principles of oxygen therapy : To increase the baseline resting partial pressure of arterial oxygen to increase the baseline resting partial pressure of arterial oxygen

22. SURGICAL MANAGEMENT Bullectomy : to remo ve damaged air sacs in the lungs lung volume reduction surgery

23. Lung transplantation

24. PULMONARY REHABILITATION Patient education Breathing exercises Activity pacing Self care activities

25. Contd … Physical conditioning Oxygen therapy Nutritional therapy Coping measures Palliative care

26. NURSING MANAGEMENT Ineffective airway clearance related to excessive secretion and ineffective coughing Impaired breathing pattern related to decreased ventilation and mucous plugs Activity intolerance related to inadequate oxygenation and dyspnea Risk of potential complication related to chronic pulmonary obstructive disease

27. COMPLICATIONS Respiratory insufficiency Respiratory failure Pneumonia Chronic atelectasis Respiratory infections Pneumothorax Pulmonary artery hypertension .

28. GENERAL ADVISE Take the medications regularly as prescribed, if having any doubt reach to the nearby hospital. Exercise regularly every day or else at least 4 out of 7 days. Remember to take vaccination regularly Stay away from infections by maintaining good hygiene Quit smoking Eat a regular balanced diet Drink plenty of plain fresh water at least 1.5l/day Drink caffeinated drinks and alcohol in moderation Get plenty of sleep

29. Conclusion Chronic obstructive pulmonary disease is a preventable and treatable progressive lung disease. People with COPD works harder to breathe, which can lead to shortness of breath, and/or feeling tired. Early in the disease, people with COPD may feel short of breath when they exercise. A person with COPD may have obstructive bronchitis, emphysema, or a combination of both conditions. The amount of each of these conditions differs from person to person. With proper use of MDI, pulmonary rehabilitation and following medical management the disease progression can be reduced and surgical management is the last resort for these patients.

30. REFERENCES Brunner and suddharths . Textbook of medical and surgical nursing. 13th edition vol. I. .New delhi : reed elsevier india pvt. Ltd.; 2014. Pg. No. 360- 395 Lewis. Medical surgical nursing. Assessment and management of clinical problems. 2015. New delhi . Elsevier vol. I. Pg. No. 461-493 Joyce M. Black and jane hokanson ; medical surgical nursing; volume 2, 8 th edition, reed elsevier , india pvt. Https://www.Thoracic.Org/.../patient-resources/resources/ copd-intro.Pdf Https://www.Who.Int/medicines/areas/priority_medicines/BP6_13COPD Research hyperlinks: Altman, pablo et al. “Comparison of peak inspiratory flow rate via the breezhaler ®, ellipta ® and handihaler ® dry powder inhalers in patients with moderate to very severe COPD: a randomized cross-over trial.” BMC pulmonary medicine vol. 18,1 100. 14 jun. 2018, doi:10.1186/s12890-018-0662-0 Ali, lilas et al. “Need of support in people with chronic obstructive pulmonary disease.” Journal of clinical nursing vol. 27,5-6 (2018): e1089-e1096. Doi:10.1111/jocn.14170

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