COPD

CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
GROUP 1 (5C)

1) SR. ROSNI BT ABDUL RAHIM

2) SN. SITI NORLIANA BT MOHAMAD
3) SN. SALWANI BT ABU HASAN
4) SN. MOHAMAD NAZUEIN B M.SHAFIIN
5) SN. SUAZRIN BT SUPIAN
6) SN. SITI AMIZA BT MOHAMED SAHAK
WHAT IS COPD ?
A condition in which;
 The lungs have become permanently altered.

 The airway in the lungs are constantly narrowed.

 Chronic inflammation creates difficulty in

breathing.
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 COPD includes :
1) Chronic Bronchitis

2) Emphysema
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WHAT DOES COPD DO ?
ETIOLOGY
PATOPHYSIOLOGY
 COPD is a complex syndrome comprised of airway
inflammation, mucociliary dysfunction and consequent
airway structural changes.

 Airway remodeling in COPD is a direct result of the

inflammatory response associated with COPD and
leads to narrowing of the airways. Three main factors
contribute to this: peribronchial fibrosis, build-up of scar
tissue from damage to the airways and over-
multiplication of the epithelial cells lining the airways.
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 COPD is characterized by chronic inflammation of the
airways, lung tissue and pulmonary blood vessels as a
result of exposure to inhaled irritants such as tobacco
smoke.
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CASE STUDY
 PATIENT DATA
 NAME : MR. A
 AGE : 62 YEARS OLD
 RN : 1726731
 GENDER : MALE
 RACE : INDONESIAN
 OCCUPATION : CHICKEN FOOD (PULLET) PACKAGER
 DIAGNOSIS ON : CHRONIC OBSTRUCTIVE PULMONARY
ADMISSION DISEASE 2⁰ COMMUNITY ACQUIRED
PNEUMONIA
 UNDERLYING : I) HYPERTENSION SINCE 1 YEAR
II) DIABETES MELLITUS
III) COPD SINCE 10 YEARS.
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 Vital sign on arrival at ED : BP : 160/92 mmHg, HR:
100 bpm, RR : 24/min, SPO2 : 94% under room air,
T: 37.1⁰C
 GCS : 15/15
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 ADDMISSION AT 8B
 15/4/2017 : Sputum AFB X3 POSITIVE
 Treated as pulmonary tuberculosis. TB drug started
on 15/4/2017- T. Akurit 4tab TDS and T.
Pyrazinamide 20mg OD. Patient develop skin
reaction and hepatitis. Changed to regular TB drug.
 Transferred to 7C for isolation.

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 2/5/2017 : Patient develop shortness of breath, restless, respiratory distress,
GCS: 12/15,BP: 158/90mmHg, HR: 120 RR: 39/min SPO2:98% on
nebuliser 3x and decided for intubation.
 NO ABG DONE PRE-INTUBATION.
 ABG POST-INTUBATION (IN WARD):
PH 7.43
Pco2 42.2mmHg
Po2 66.2mmHg
HCO2 13.7
ABE 3.3
HCO3 27.2

 Sent patient to 5c
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 Case transfer in from 7C on 2/5/2017 at 2330H .
 Ventilated with SIMV/VC mode, setting.

Fio2 :0.4 , Tidal Volume: 480 , Peep :8 ,

Pressure support 12 , Rate : 12
 Reason for simv(vc) :
i. Friendly mode.
ii. ABG show patient in Respiratory Acidotic, need mandatory
breath to wash out CO2.
iii. Good lung compromised
iv. Patient was sedated to reduced anxiety and to optimise the
ventilation work.
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 ABG result on admission to 5C
PH 7.253
PaCO2 58.3 mmHg
PaO2 111 mmHg
HCO2 20.8
BE -3.2
SaO2 97%

 ABG show respiratory acidosis

 Adequate oxygenation.
 No special order, continue current setting.
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 ABG done on 3/5/2017 at 0500H:
PH 7.361
PaCO2 38.9 mmHg
PaO2 109 mmHg
HCO3 21.9
BE -2.1
SaO2 99%

 Change to CPAP mode at setting,

FIO2 :0.4, PEEP:8 ,PS:12.
Reason on CPAP Mode

 Breathing effort present

 Good oxygenation
 No inotropic support
 GCS improving
 Less acidotic ABG
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 ABG on CPAP mode 3/5/2017 at 1000H

PH 7.433
PCO2 40.0mmHg
PO2 116mmHg
HCO2 23.9
BE 0.6
SPO2 97.9%
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 Patient ready to be extubate; reason:
i. Normal pH in ABG
ii. GCS full
iii. Good breathing effort
 Patient was extubated at 1100H and put on ventimask 60% at 10L/min,
subsequently changed to nasal prong 4L/min.
 ABG on nasal prong 4L/min (post extubation after 1hour)
PH 7.428
PCO2 36.5 mmHg
PO2 101mmHg
HCO3 24.5
BE -0.2
SPO2 97.15%

 No special order, continue on nasal prong 4L/min

THANK YOU