21 Mar 2020

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  2. INTRODUCTION • Chronic obstructive pulmonary disease (COPD)is a preventable & treatable disease state characterised by airflow limitation that is not reversible .The airflow limitation is usually progressive & associated with an abnormal inflammatory response to lungs to noxious particles caused by cigarette smoking .
  3. • The term chronic obstructive pulmonary disease encompasses 2 types of obstructive airway diseases, chronic bronchitis , emphysema . Chronic bronchitis is the presence of chronic productive cough for 3 months in each of 2 consecutive years in a patient . Emphysema is an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by the destruction of their walls and without obvious fibrosis.only 10% of patients with COPD have pure Emphysema.
  4. DEFINITION:- • Chronic obstructive pulmonary disease (COPD) is a disease state characterized by the presence of airflow obstruction caused by chronic Bronchitis or emphysema. The airflow obstruction is generally progressive, may be accompanied by airway hyperactivity, and may be partially reversible.
  5. CHRONIC BRONCHITIS • Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of two Consecutive years. In much case, smoke or other environment pollutants irritates the airways, resulting in hyper secretion of mucus and inflammation.
  6. EMPHYSEMA: • In emphysema, impaired gas exchanges results from destruction of the walls of over distended alveoli “emphysema in a pathological form that describes an abnormal distention of the air spaces beyond the terminal bronchioles, with destruction of the walls of the alveoli.
  7. TYPES There are two main type of emphysema. • 1. Pan lobular (Panacinar) • There is destruction of the respiratory bronchiole, alveolar duct, and alveoli. All air space within the lobule are essentially enlarged, but there is little inflammatory disease. The patient shows hyper inflated (hyper expended) chest (barrel chest on physical examination), dyspnea and weight loss.
  8. 2. Centrilobular • In this from, pathologic changes takes place mainly in the center of the secondary lobule. In which the respiratory bronchioles enlarge, the walls are destroyed and the bronchioles became inflamed. Frequently, there is a derangement of ventilation- perfusion ratios, producing chronic hypoxemia, hypercapnia, poly cythemia and episode of right side heart failure.
  9. Causes and risk factors • 1) Cigarette Smoking: - • It is major risk factors. The prevalence of cigarette smoking in the United States has decreased since 1964. Nearly all-first use of tobacco occurs before high school graduation, and each day 3000 teenagers start to smokes. • Clinically significant airway obstruction develops in 15% of smokers, and 80-90% of COPD deaths in united sates related to tobacco smoking, when cigarettes are smoked. Approximately 4000 chemicals and gases are inhaled into the lungs.
  10. • 2) Infection: - • Recurrent respiratory tract infections. • 3) Passive smoking • 4) Occupational exposure • 5) Air pollution • 6) Heredity: - Genetic abnormality including a deficiency of alpha1, ( 1) antitrypsin (AAT), an enzyme inhibitor that normally counteracts the destruction of lung tissue by certain other enzyme. • Bronchial edema • Hyper secretion of mucus • Broncho spasm • 7) Aging
  11. INCIDENCE • COPD is the fifth leading causing factor of death in the united stated states for all ages and both genders; fifth for men and fourth for women. More than 15 million persons in the united status suffer from emphysema and chronic bronchitis.
  12. Chronic Bronchitis Bronchial edema Hyper secretion of mucus Broncho spasm Tobacco Smoke Air Pollution 1Anti trypsin Deficiency Break down of elastin in Connective tissue of lungs Continual bronchial Irritation and inflammation Emphysema Destruction of alveolar septa Air way instability Airway obstruction Dyspnea Frequent infections
  13. Abnormal ventilation – Perfusion ratio Hypoxemia Hypoventilation Cor pulmonale Hypoxia Reduction of Pulmonary Vascular bed Acidosis and Hypercapnia Pulmonary Vasoconstriction Polycythemia Pulmonary Vasoconstriction increase Pulmonary vasculature Resistance Pulmonary Hypertension Right Ventricular Hypertrophy Cor Pulmonale Congestive heart Failure (Right Sided)//
  15. CLINICAL MANIFESTATION • • COPD is characterized by three primary symptoms • Cough (mucopurulent, scanty, mucoid) • Sputum production • Dyspnea on exertion • Weight loss because dyspnea interferes with eating • Barrel chest • Hypoxemia during exercise • Cyanosis
  16. • DIAGNOSTIC FINDING: – Extensive history collection. • Exposure to risk factors – types, intensity, duration • Past medical history – respiratory disease, allergy, asthma • Family history of COPD • Pattern of symptoms development • History of previous hospitalizations for respiratory problems. • Current medical treatments • Potential for reducing risk factors (eg. Smoking cessation) – Physical examination – Spirometry: - to evaluate airflow obstruction. – ABG analysis – Chest X-Ray – Bronchodilator reversibility Test – Alpha1, antitrypsin deficiency screening – Pulmonary function Test – ECG • Echo – cardiogram
  17. MANAGEMENT • Risk reduction • Smoking cessation is the single most effective intervention to prevent COPD. • Pharmacological therapy • A) Broncho dilators • Several classes of Broncho dilators are used • Beta-adrenergic agonist agents • Albuterol , Pirbuterol, Terbutaline • b) Anticholinergic Agents • Ipratropium bromide • Oxitropium bromide • c) Methylxanthines • Aminophylline, Theophylline
  18. • B) Corticosteroids • Beclomethasone • Budesonide • Flunisolide • • C) Alpha1antitrypsin augmentation therapy • D) Antibiotic agents • E) Anti tussive agents • F) Oxygen therapy: - it can be administered to prevent dyspnea.
  19. SURGICAL MANAGEMENT • 1. BULLECTOMY • Bullae are enlarged air spaces that do not contribute to ventilation but occupy space in the thorax. These areas may be surgically excised. Many times this area has adequate gas exchanges. Bullectomy may help reduce dyspnea and improve lung function. It can be done thoraco scopically or via a limited thoracotomy incision.
  20. 2. LUNG VOLUME REDUCTION SURGERY • This is used in end stage COPD (STAGE- III). It involves the removed of a portion of the diseased lung parenchyma. This allows the functional tissue to expend, resulting in improved elastic recoil of the lungs and improved chest wall. This type of surgery does not cure disease, but it may decrease dyspnea, improve lung function and improve the patient overall quality of life.
  21. 3. LUNG TRANSPLANTATION • Lung transplantation is a viable alternative for definitive surgical treatment of end stage emphysema. It has been shown to improve quality of life and functional capacity but organs are short supply and many patient die while waiting for a transplant.
  22. DIETARY MANAGEMENT • Liquid, blenderized diet may be given • Foods that require a great deal of chewing should be avoided • Avoid exercise for at least 1 hour before and after eating • Avoid gas-forming foods such as cabbage, beans) • High protein and calorie diet given • Avoid high CHO diet • Avoid sodium if this is heart failure.
  24. ASSESSMENT • The nurses play a key role to manage the client condition. • Assess the general and respiratory condition of the patient. • Collect the important health information • Assess the functional health patterns • Physical examination.
  25. NURSING DIAGNOSIS: - 1.Impaired gas exchange and airway clearance due to chronic inhalation of toxin. • Goal: - improvement in gas exchange • Intervention: • Evaluates current smoking status, educate regarding smoking cessation • Provide comfortable position • Administer and teach appropriate use of bronchodilators • Administer O2 to increase O2 saturation.
  26. 2. Impaired gas exchange related to ventilation – perfusion inadequately • Goal: - improvement in gas exchange. • Intervention: – Administer bronco dilators – Evaluate effectiveness of nebulizer – Instruct and encourage patient in diaphragmatic breathing and effective coughing. – Administered O2 – Instruct the patient to avoid smoking – Provide comfortable position.
  27. 3.Ineffective airway clearances related to bronco constriction, increased mucus production. • Goal: - Achievement of airway clearance. • Intervention: • Adequately hydrate the patient • Teach and encourage the use of diaphragmatic breathing and coughing techniques. • Assist in nebulizer. • Avoid the smoking • Administer antibiotic
  28. 4.Ineffective breathing pattern related to shortness of breath, mucus and airway irritants. • Goal: - improvement in breathing pattern. • Intervention: • Facilitate deep breathing by elevating head • Provide semi fowler position • Encourage alternating activity with rest period
  29. 5. Imbalance nutrition: less than body requirement related to poor appetite • Goal: - improve the nutritional status • Intervention: • Monitor calorie intake, weight. • Provide menu suggestion for high protein & calorie foods • Give high protein and calorie diet. • Provide liquid and frequent diet
  30. Thanks to all