Chronic obstructive pulmonary disease COPD Dr Walaa Nasr

Chronic obstructive pulmonary disease (COPD) Dr. Walaa Nasr Lecturer of Adult Nursing Second year

n Out lines COPD What is the COPD? n Overview n Causes of COPD n Symptoms of COPD n What's the difference between COPD and asthma? n Diagnostic tests needed for COPD n Medical management of COPD n Preventive measures n Nursing intervention n Outlook and Prognosis n

COPD Definition COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

COPD Overview

COPD Overview n n n 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 tends to clog them.

COPD Causes n. Smoking n. Air pollution ngenetic (hereditary) risk

COPD Symptoms n Productive cough n Breathlessness n Chest infection n Other symptoms of COPD can be more vague, weight loss, tiredness and ankle swelling.

Difference between COPD and Asthma n n n In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are chronic (persistent). Treatment to open up the airways, is therefore limited. In asthma there is inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well. COPD is more likely than asthma to cause a chronic (ongoing) cough with sputum.

Difference between COPD and asthma (cont…) n n Night time waking with breathlessness or wheeze is common in asthma and uncommon in COPD is rare before the age of 35 whilst asthma is common in under-35.

COPD Diagnostic tests n n n n Symptoms Physical examination Sample of sputum Chest x-ray High-resolution CT (HRCT scan) Pulmonary function test (spirometery) Arterial blood gases test Pulse oximeter

COPD n n n Medical management 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.

COPD Medical management (cont…) n Stop smoking n Oxygenation with low concentration during the acute episodes n In asthma adrenaline ( epinephrine) SC if the bronchospasm not relieved. n Aminophylins IV if the above treatment does not help. n IV corticosteroids for patients with chronic asthma or frequent attack. n Sedative or tranquilizers to calm the patient. n Increase fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation. n Intubations and mechanical ventilation if there is respiratory failure.

COPD Preventive measures n To prevent irritation and infection of the airways, instruct the patient to: n Avoid exposure to cigarette, pipe, and cigar smoke as well as to dusts and powders. n Avoid use of aerosol sprays. n Stay indoors when the pollen count is high. n Stay indoors when temperature and humidity are both high

COPD Preventive measures (cont…) n n Use air conditioning to help pollutants and control temperature decrease Avoid exposure to persons known to have colds or other respiratory tract infection Avoid enclosed, crowded areas during cold and flu season. Obtain immunization against influenza and streptococcal pneumonia.

COPD Preventive measures (cont…) n n n To ensure prompt, effective treatment of a developing respiratory infection, instruct the patient to do the following: Report any change in sputum color character, increased tightness of the chest, increased dyspnea, or fatigue. Call the physician if ordered antibiotics do not relieve symptoms within 24 hours.

COPD Nursing intervention n Assessment n History Patient's environment n Work history, exercise pattern, smoking habits n The onset & development of symptoms n Sleeping positions n

COPD Nursing intervention (cont…) n Physical examination Signs of heavy smokers n Observe for clubbing n Distended neck vein on expiration n The presence of barrel chest n Observe for abdominal breathing n The use of pursed lips breathing and chest movement n Auscultate the chest& listen for musical wheezes characteristics of chronic bronchitis

COPD Nursing intervention (cont…) n n n review the results of diagnostic procedure: Arterial blood gases Pulmonary function tests X-ray films Nursing diagnosis n Ineffective breathing pattern related to increase need of O 2 n Ineffective airway clearance related to excessive accumulation of secretions n Impaired gas exchange expiration &co 2 retention related to impaired

COPD Nursing intervention (cont…) n n n Activity intolerance related to inadequate oxygenation High risk for ineffective individual coping related to chronic disease, its effects& its treatment High risk for altered health maintenance related to insufficient knowledge of prevention, identification and treatment of respiratory complication of COPD