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- 1. Mr. Yahye SheikhAbdulle Msc Nursing 1st year Kle college of Nursing Chronic obstructive pulmonary diseases
- 2. Chronic obstructive pulmonary diseases COPDis also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease (CORD) Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema, a pair of two commonly co- existing diseases of the lungs in which the airways become narrowed.
- 3. This leads toa limitation of the flow of air to and from the lungs causing shortness of breath.
- 4. In COPD, lessair 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.
- 6. Incidence It isthe 4th leading cause of mortality and 12th leading cause of disability in the united states. In 2020 COPD is the 3rd leading cause of death.
- 7. CAUSES Smoking. Smoking isprimary risk factors for COPD. The numerous irritants found in cigarette smoke stimulate excess mucus production and coughing, destroy ciliary function and lead to inflammation and damage of bronchiolar and alveolar walls.
- 9. Air pollution highlevels of urban air pollution are harmful to persons with existing lung disease. However, the effect of outdoor air pollution as a risk factor for COPD. Another risk factor for COPD development is fossil fuels that used for indoor heating and cooking.
- 10. Occupational exposures- exposure toworkplace dusts found in coal mining, gold mining, and the cotton textile industry and chemicals such as cadmium, and fumes from welding have been implicated in the development of airflow obstruction. Exposure of these irritants causes the airway to be hyper responsive.
- 11. Infection :infections isrisk factor for developing COPD. Severe recurring respiratory tract infection in childhood have been associated with reduced lung function and increased respiratory symptoms in adulthood. Recurring infections impair normal defense mechanisms, making bronchioles and alveoli more susceptible to injury.
- 12. Genetics-Alpha 1-antitrypsindeficiency is a genetic condition that is responsible for about 2% of cases of COPD. In this condition, the body does not make enough of a protein, alpha 1-antitrypsin. Alpha 1- antitrypsin protects the lungs from damage caused by protease enzymes, such as elastase and trypsin, that can be released as a result of an inflammatory response to tobacco smoke
- 13. RISK FACTORS FORCOPD
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- 15. pathophysiology COPD is characterizedby airflow limitation that is poorly reversible. chronic exposure to cigarette smoking is the number one cause of the disease, but repeated exposure to secondhand smoke, air pollution and occupational exposure (to coal, cotton, grain) are also important risk factors.
- 16. Smoking and otherairway irritants cause neutrophils, T-lymphocytes, and other inflammatory cells to accumulate in the airways. Once activated, they trigger an inflammatory response in which an influx of molecules, known as inflammatory mediators, navigate to the site in an attempt to destroy and remove inhaled foreign debris.
- 17. Under normal circumstances,the inflammatory response is useful and leads to healing. In fact, without it, the body would never recover from injury. In COPD, repeated exposure to airway irritants perpetuates an ongoing inflammatory response that never seems to shut itself off. Over time, this process causes structural and physiological lung changes that get progressively worse.
- 18. As inflammation continues,the airways constrict, becoming excessively narrow and swollen. This leads to excess mucus production and poorly functioning cilia, a combination that makes airway clearance especially difficult. When people with COPD cannot clear their secretions, they develop the hallmark symptoms of COPD, including a chronic, productive cough, wheezing and dyspnea.
- 19. Finally, the build-upof mucus attracts a host of bacteria that thrive and multiply in the warm, moist environment of the airway and lungs. The end result is further inflammation, the formation of diverticula in the bronchial tree, and bacterial lung infection, a common cause of COPD exacerbation.
- 20. CLINICAL FEATURES Chroniccough Sputum production Wheezing Chest tightness Dyspnoea on exertion Wt.loss Respiratory insufficiency Respiratory infections Barrel chest- chronic hyperinflation leads to loss of lung elasticity.
- 21. Bronchitis Bronchitis resultsfrom inflammation of bronchi leading to increased musus production, cough and eventual scaring of the bronchial lining. acute (short term) Infections or lung irritants cause acute bronchitis. chronic is an ongoing, serious condition. It occurs if the lining of the bronchial tubes is constantly irritated and inflamed, causing a long-term cough with mucus It is defined as the presence of cough and sputum production for atleast 3 months.
- 22. Chronic bronchitis ischaracterized by the following : A increased in size and number of submucus glands in the large bronchi, which increase mucus production. An increased number of goblet cells which also secrete mucus. Impaired cillary function which reduce mucus clearance.
- 24. PATHOPHYSOPLOGY Irritants irrritatethe airway Excess mucus production Inflammation Cause the mucus secreting glands and goblet cells to increase in number. Ciliary function is reduced
- 25. More mucusproduction Bronchial walls become thickened and lumen narrows and mucus plug the airway Alveoli adjacent tto the bronchioles may become damaged and fibrosed. Alter function of alveolar macrophages. Infection
- 26. Signs and symptoms-Acute sore throat, fatigue (tiredness), fever, body aches, stuffy or runny nose, vomiting, and Diarrhea persistent cough cough may produce clear mucus shortness of breath
- 27. Chronic symptoms coughing, wheezing, and chest discomfort. The coughing may produce large amounts of mucus. This type of cough often is called a smoker's cough.
- 28. EMPHYSEMA Definition:- Emphysema is definedas enlargement of the air spaces distal to the terminal bronchioles, with destruction of their walls of the alveoli. As the alveoli are destroyed the alveolar surface area in contact with the capillaries decreases. Causing dead spaces (no gas exchange takes place) Leads to hypoxia.
- 29. In later stages: CO2elimination is disturbed and increase in CO2 tension in arterial blood causing respiratory acidosis
- 30. There are threetypes of emphysema 1. Centriacinar 2. Panacinar 3. Paraseptal
- 31. Centriacinar(centrilobular) emphysema themost common type produce destruction in bronchioles usually in the upper lung region. Inflammation begins in the bronchioles and spread peripherally but usually the alveolar sac remains intact. This form of emphysema occurs most often in smokers.
- 32. Panicar emphysema destroysthe entire alveolus and most commonly involves the lower portion of the lung. This form of disease is generally observed in individuals with ATT deficiency.
- 33. Paraseptal or distalacinar emphysema primarily involves the distal airway structures alveolar ducts and alveolar sacs. The process is localized around the septa of the lung or pleura. It is believed to be the likely cause of spontaneous pneumothorax
- 34. DIAGNOSIS Blood Test Blood testscan help determine if symptoms are being caused by an infection. An arterial blood gas test will measure the amount of oxygen in blood. This is one indication of how well lungs are working. This can help doctor determine how severe COPD is and whether need oxygen therapy.
- 35. . Chest X-rayor CT scan A CT scan is a type of X-ray that creates a more detailed image than a standard X-ray. Whichever type doctor chooses, an X-ray will give a picture of the structures inside chest. These include your heart, lungs, and blood vessels. Your doctor will be able to see if client has evidence of COPD. If symptoms are being caused by another condition such as heart failure, the doctor will be able identify that as well
- 36. Sputum Examination Doctor mayorder a sputum examination, especially if the client has a productive cough. Sputum is the mucus the client cough up. Analyzing sputum can help identify the cause of breathing difficulties and may rule out some lung cancers. If there is a bacterial infection, it can be identified and treated. ECG The doctor might request an ECG to determine if your shortness of breath is being caused by a heart condition.
- 37. Pulmonary Function Test pulmonary function tests (PFTs) measure how well the lungs are moving air in and out. They also measure how well the lungs are moving oxygen to the blood. Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs). It measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.
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- 40. MEDICAL MANAGEMENT The treatmentgoal for the client with COPD are: To improve ventilation To facilitate the removal of bronchial secretions To promote health maintenance To reduce complications, and To slow progression of the disease
- 41. Smoking cessation Cessation ofcigarette smoking is single most effective and cost effective intervention to reduce the risk of developing COPD and stop the progression of the disease. After discontinuation of smoking, the accelerated decline in pulmonary function slows and pulmonary function usually improves.
- 42. Drug therapy Medications forCOPD: Reduce symptoms Increase the capacity of exercise, Improve overall health and Reduce the severity of exacerbations.
- 43. Bronchiodilator drug therapyare agents that widen the air passages by relaxing the bronchial smooth muscle and improve the ventilation of lungs. They are usually administered via inhalation route but in rare occasions may be given orally or administered intravenously. Regular treatment with long acting bronchiodilators is more effective and convenient than treatment with short acting forms.
- 44. The principal bronchiodilatortreatment are Beta2 agonists, anticholinergics, and methylxanthines used singly or combination. The choice of bronchioldilators depends on availability and patient’s response. Beta2 agonists are sympathomimetic drugs that acts on the beta-adrenoceptors in the smooth muscles of the airway and cause bronchioldilation. These drugs may also enhance mucus clearance and improve the endurance of respiratory muscles.
- 45. Short actingBeta2 agonists(e.g., albuterol)have minimal adverse effects with rapid onset of action, a peak effect in 60 to 90 minutes and duration of 4 to 6 hour. Side effects that may develop with the use of these drugs are tachycardia, tremor, nervousness, and nausea. Anticholinergic agents offer greater bronchiodilator effect and fewer side effect than short acting inhaled beta2 agonists. These drugs work by blocking the cholinergic receptors located in the larger airways, resulting in bronchiodilation. Ipratropium(atrovent) is the most commonly used drug in this category.
- 46. Oxygen therapy O2 therapyis frequently used in the treatment of COPD another problem associated with hypoxemia. Long term o2 therapy improves survival, exercise capacity, cognitive performance and sleep in hypoxemic patients.O2 is colorless, odorless testless gas that constitutes 20.95% of the atmosphere. O2 raises the partial pressure of oxygen(PO2) in inspired air. Indications for use: goals for 02 therapy are To reduce the work of breathing, To maintain the PaO2 To reduce the workload of heart To keep the SaO2 more than 90% during rest
- 47. Oxygen is usuallyadministered to treat hypoxemia caused by Respiratory disorders such as COPD pulmonary hypertension pneumonia and pulmonary emboli Cardiovascular disorders such as myocardial infraction, angina pectoris and cardiogenic shock Central nervous system disorders such as overdose of opiods
- 48. SURGICAL MANAGEMENT bullectomy Bullae areenlarged airspaces that do not contribute to ventillation but occupy space in the thorax,these areas may be surgically excised lung volume reduction surgery It involves the removal of a portion of the diseased lung parenchyma.this allows the functional tissue to expand. lung transplantation
- 49. Nursing management Nursing diagnosis Impairedgas exchange related to decreased ventilation Objectives Improve ventilation Intervention a. Monitor lung sounds every 4 to 8 hours. b. Perform chest physiotherapy c. Advice the client to drink at least 8 to 10 glasses of fluid per day unless contraindicated d. Teach the client in coughing technique e. Asses the condition of oral mucus membrane and perform oral care
- 50. Nursing diagnosis Disturbed sleeppattern related to dyspnea Objectives Getting adequate rest Intervention Promote relaxation by providing a darkened, quiet environment, ensure adequate room ventilation. Avoid use of sleeping pills Schedule care activities to allow periods of uninterrupted sleep.
- 51. Nursing diagnosis Activity intolerancerelated to inadequate oxygenation Objective Improve to perform daily activity Intervention Monitor the severity of dyspnea Stop or slow any activity that leads to change in respiratory rate Advice the client to avoid conditions that increase oxygen demand
- 52. Nursing diagnosis Anxiety relatedto acute breathing difficulties and fear of suffocation Objectives Relieve fear of dying Intervention Provide a quiet, calm environment. During acute episodes, open doors and curtains and limit the number of people in the room. Encourage the use of breathing retraining and relaxation technique Give sedative and tranquilizers with extreme caution. Nonpharmacological methods of anxiety reduction are more useful
- 53. Nursing diagnosis Ineffective airwayclearance related to excessive secretions and ineffective coughing Objective Effective airway clearance Intervention Monitor lung sounds every 4 to 8 hours. Perform chest physiotherapy Advice the client to drink at least 8 to 10 glasses of fluid per day unless contraindicated Teach the client in coughing technique Asses the condition of oral mucus membrane and perform oral care
- 54. Complications More frequentlung infections, such as pneumonia. An increased risk of thinning bones (osteoporosis), especially if you use oral corticosteroids. Problems with weight. If chronic bronchitis is the main part of your COPD. Heart failure affecting the right side of the heart (cor pulmonale). A collapsed lung (pneumothorax). Sleep problems.