disease of the airway © Comprises primarily of two related disease- chronic bronchitis and Emphysema ° Chronic obstruction of the flow of air through the airway and out of the lungs permanent and progressive obstruction over time* COPD is the 5* leading cause of death in the United States for all ages and both genders; fifth for men and fourth for women « Men were found to have a prevalence of 11.8% and women 8.5%. The numbers vary in different regions of the world © more than 12,000 persons died of COPD. The middle adult years, and the incidence of COPD increases with age Chronic bronchitis* Chronic bronchitis is defined clinically as a daily cough with production of sputum at least 3 month per year for 2 or more consecutive year. © It involves inflammation and swelling of the lining of the air way that leads to narrowing and obstruction of the air way. ° The inflammation also stimulate production of mucus which can cause further obstruction of the airway. e° It is permanent enlargement of the alveoli due to destruction of the wall between alveoli which leads to reduce the elasticity of the lungs over all. © Loss of elasticity leads to collapse of the bronchioles, obstructing air flow out of the alveoli. Air become trapped to the alveoli and reduce the ability of the lungs to shrink during exhalation .TO « Reduce the expansion of the lungs during the next breath reduce the amount of air that is inhaled ° As aresult, less air for the exchange of gasses gets in to the lungs . This trapped air also can compress adjacent less damage lung tissue.© The specific causes of COPD are not clearly understood. Some risk factors are tissue. 1.Cigarette smoking. The primary cause is exposure to tobacco smoke. cigarette smoking will develops COPD in 15% .Overall, tobacco smoking accounts for as much as 90% of the risk of COPD . ° Secondhand smoke_ SE rCti‘(C;étCS © Secondhand smoke, or environmental tobacco smoke, increases the risk of respiratory infections. 2.Air Pollution © outdoor air pollution contributes to the development of COPD. © most common cause is indoor stoves for cooking © Some occupational pollutants such as cadmium and silica-contd 3.Alpha-1 Antitrypsin (AAT) deficiency- e AAT enzyme is produced by liver and present in normal lungs. Normalt.5-3.5 g/l. Block the damaging effects of elastase on elastin. 4. Chronic Respiratory Infections 5. Alcohol IngestionIncrease number of goblet cell and TgE stimulation mucus == Increase size and number of Fat abtochedt0 th is : mast cel submucus gland in bronchi and mucus production Mast cell release histamine Decrease cillary function reduce mucus and tresses) pace (deposit mucus Mucus secretion and ive ait <—_ bronchos Bronchi constriction a recetiverait ranchespasm“SIGN AND SYMPTOMS » Cough, with or without mucus ° Chronic cough and sputum production (in chronic bronchitis © Shortness of breath (cyspnec) that gets worse with mild activity * Trouble catching one's breath » Fatigue ° Wheezing ° Rhonchi, decreased intensity of breath sounds, and prolonged exp ration on physical examination » chest tightness and tiredness * People with advanced COPD sometimes develop resp ratory failureCommon signs are: © Tachypnea a rapid breathing rate ° Wheezing sounds or crackles in the lungs heard through a stethoscope Breathing out taking a longer time than breathing in e Enlargement of the chest, particularly the front- to-back distance (hyperaeration) ° breathing through pursed lips e Increased anteroposterior to lateral ratio of the chest (i.e. barrel chest)© Medical History Physical examination finds enlarged chest cavity and wheezing. Blood Test ° Ahematocrit value of more than 52% in males and more than 47% in female indicates disease. e Measure the alphal-antitrypsin (AAT),the AAT level is lowmucoid sputum . * The pathogens Streptococcus pneumoniae and Haemophilus influenzaeCONTD Chest X-ray- ° Hyper inflated lung Flat diaphragm © Tubular heart ° Increase broncho vascular markingssevere bullous* High Resolution CT scanning(HRCT): is highly specific for diagnosing emphysema, and the outlined bullae are not always visible on a radiograph. © CT scan (COPD) © Two-dimensional echocardiography may be helpful as a screening tool to estimate pulmonary arterial systolic pressure and right ventricular systolic function.TO Pulmonary Function Test ° Forced expiratory volume in 1 second (FEV;) is a reproducible test and is the most commonly used index of airflow obstruction. Mild= FEV, >80% predicted ° Moderate= FEV, 80-50% predicted ° Sever= FEV, 50-30% predicted ° Very sever = FEV, <30% predicted« Arterial blood gas analysis: As the disease progresses, severe hypoxemia and hypercapnia.OE © Hypercapnia commonly is observed as the FEV; falls below 1L/s or 30% of the predicted value ° Lung volume measurements often show an increase in total lung capacity, functional residual capacity, and residual volume. © The vital capacity often decreasesTidal Volume (TV): © volume of air inhaled or exhaled with each breath during quiet breathing Total Lung Capacity (TLC): © Sum of all volume compartments after maximum inspirationInspiratory Reserve Volume : © maximum volume of air inhaled from the end- inspiratory tidal position Expiratory Reserve Volume : © maximum volume of air that can be exhaled from resting end-expiratory tidal position° Respiratory Infections ° Acute Respiratory Failure © Spontaneous Pheumothorax due to rupture of emphysematous bleb. e Ventilation Perfusion Mismatch ° Hypoxemia © CorpulmonaleThe treatment goal for the client with COPD is © To improve ventilation © To facilitate the removal of bronchial secretions © To prevent complications © To slow the progression of clinical manifestations © To promote health maintenance and client management of disease.© Quitting cigarette smoking © Taking medications to dilate airways( bronchodilators) ° Vaccinating against flu influenza and pneumonia e Regular oxygen supplementation e Pulmonary rehabilitation© Quitting cigarette smoking: most important treatments for COPD. Patients who continue to smoke have a more rapid deterioration in lung function when compared to others who quit. ° If one stops smoking, the decline in lung function eventually reverts to that of a non- smoker© Bronchodilators: Beta2 agonists are the most frequently prescribed, (albuterol or salbutamol, metaproterenol) have minimal adverse effects, rapid onset of action Anticholinergic : bronchodilators work by blocking the cholinergic receptors resulting in bronchodilatation.( Atrovent) is the most commonly used drug in this category. © Methylxanthines(theophylline, aminophylline) are also used to treat acute exacerbations,heart failure and pulmonary hypertension. ° Corticosteroids are used in the acute management of clients with COPD exacerbations © Inhaled corticosteroids like Beclomethasone diproprionate, salmeterol and fluticasone are used.OT © Regular oxygen therapy: Regular oxygen therapy is required when the client has severe exertion or resting hypoxemia (pao2 < 40mm of Hg). Oxygen (1-3L) by nasal canula may be required to raise the pao2 to no less than 60mm of Hg. (normal 80-100 mm of Hg)© Postural drainage and chest physiotherapy they can be help expelled secretion. © Control complications: Edema and corpulmonale are treated with diuretics and digitalis. ° Phlebotomy also reduces cardiac workload. * Antibiotic- Treat with antibiotic therapy for recurrent bacterial infection.° Promote exercise- Aerobic exercise ‘Exercise does not improve lung function more effectively but strengthen the respiratory muscles even the lungs are diseased. Progressively increased walking is the most common form of exercise. e Encourage diaphragmatic breathing and pursed-lip breathing.Improve general health- The most effective way to slow disease progression is for the client © to stop smoking © avoid exposure to known allergens © avoid high altitudes © Use supplemental O2 for air travel. © Adequate nutrition is essential to maintain respiratory muscle strength. © Regular O, therapy should be maintained.Assessment Assessment : ° history of smoking, family history, occupational history © ABG analysis © respiratory rate, depth and characteristics © sputum amount and type © anxiety level of the patient1.Nursing Diagnosis: Impaired gas exchange related to dyspnoea, mucus plug and decreased ventilation Goal: Client will be demonstrated improved ventilation and adequate oxygenation . Nursing intervention ° Assess respiratory rate, depth, note use of accessory muscles, pursed lip breathing, inability to speak.° Elevate head of bed, assist patient to assume position to ease work of breathing. Encourage deep slow or pursed lip breathing as individually tolerated. ° Administer low- flow oxygen therapy (1-2lit/min) as needed via nasal prongs. ° Administer bronchodilators if ordered e Regularly monitor the client's respiratory rate and pattern, pulse oximetry, ABG results.2.Nursing Diagnosis: Activity intolerance related to inadequate oxygenation and dyspnea e Nursing Goals: The client will have improved activity tolerance within hospitalization periodNursing Intervention © Monitor the severity of dyspnea and oxygen saturation with and following activity ° Keep the patient in semi- flower position. ° Maintain supplemental oxygen therapy (2lit/min) * Assist the client in scheduling a gradual increase in daily activity and exercise* Advise the client to avoid conditions that increase oxygen demand such as temperature extremes, excess weight and stress. e Instruct the client energy conservation techniques such as pacing activities throughout day. © Teach the client to use pursed-lip and diaphragmatic breathing techniques3.Nursing Diagnosis: Ineffective airway clearance related to excessive production of secretions, retained secretions and ineffective coughing Goal: The client will be maintain patent airway with breath sounds clear within hospitalization Nursing Intervention e Monitor respiratory rate and auscultate breath sounds eg. wheeze, crackles, rhonchi * Assist the patient to assume position of comfort eg elevate head of bed, sitting on edge of bed.OT © Keep environmental pollution to minimum eg dust, smoke and feather pillows according to individual situation ° Encourage/ assist with abdominal or pursed lip breathing exercises © Administer medications as indicated such as bronchodilators ° Perform chest physiotherapy.4.Nursing Diagnosis: Anxiety related to disease prognosis Nursing goal: Patient will not have any more anxiety after nursing intervention© Provide care ina calm and quiet environment. ° Encourage the use of breathing retraining and relaxation techniques. ° Explain the patient about disease including cause, signs and symptoms, medication, procedures, prevention and follow up care ° Give the opportunity to talk the patient with similar problem who admitted in the same ward and almost in recovery phase.5.Nursing Diagnosis: Risk for infection related to ineffective pulmonary clearance Goal: Client will have a decreased risk of infection related to ineffective pulmonary clearance after intervention Nursing Intervention © Teach the client to wash his or her hands after contact with potentially infectious material. © Teach the client and family how to care for and clean respiratory equipment used at home.* Assess vital signs including temperature and sputum color, odor and character. © Teach the client and family the manifestations of Bilan infections like change in color or volume of e sputum, fever, chills, malaise, productive cough, confusion, increased dyspnea etc ° Discuss need for adequate nutritional intake © Explain client about the importance of self care ° Notify the physician if any sign of infections occurs.THANK YOU