Chronic Obstructive Pulmonary Diseases (COPD)

4Nu08 Group 2: Orellosa, Diane Emmille E. Otico, Joseph S. Paat, Joden Ryan D. Pacis, Lea Therese R. Pajaro, Barbrah Allana A.

Chronic Obstructive Pulmonary Diseases (COPD)

1. Chronic Bronchitis 2. Emphysema 3. Bronchiectiasis

CHRONIC BRONCHITIS

What is Chronic Bronchitis?

Disease of the airways Presence of cough and sputum production for at least 3 MONTHS in each 2 CONSECUTIVE YEARS

Risk Factors
Age Men Cigarette Smoking Urban/industrial Area

Pathophysiology
1. 2. 3. 4. 5. 6. 7. 8. Exposure to irritants Inflamed and swollen mucosa Hypertrophy and hyperplasia of mucosal glands Increased secretion of mucus Chronic irritation thickening of bronchial wall Pooling of secretions Low O2 levels blue bloater Severe dyspnea

Signs and Symptoms

Chronic productive cough* Tachypnea* Shortness of breath* Note that COUGH and RONCHI may be more severe in the MORNING Cyanosis Hypercapnea *significant indicator of chronic bronchitis

Diagnostic Procedures
Chest X-Ray:
**hyperinflation

Pulmonary Function Tests:

Spirometry (to evaluate airflow obstruction, to determine the reversibility of obstruction after use of bronchodilators)

Arterial Blood Gases:

to determine baseline oxygenation and gas exchange

CT Chest Scan & Sputum Exam:

for differential diagnosis

Nursing Care Management

Encourage smoking cessation Educate on importance of healthy lifestyle and environment modification on respiratory status Encourage adequate fluid intake for expulsion of sputum Provide and educate on appropriate chest therapy: postural drainage, percussion, breathing exercises

Pharmacological Management
Bronchodilators Corticosteroids Nebulization Oxygen (for hypoxia) Nutritional supplements

EMPHYSEMA

What is Emphysema?
Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). Airflow on exhalation is slowed or stopped because over-inflated alveoli do not exchange gases when a person breaths due to little or no movement of gases out of the alveoli.

Risk Factors
Age Men Cigarette Smoking Deficiency of an enzyme called alpha-1antitrypsin Air pollution Airway reactivity Heredity

Pathophysiology
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Long term inhalation of harmful substances Obstruction of walls of over distended alveoli Walls of the alveoli are destroyed Pulmonary capillaries continually decreases Carbon dioxide elimination is impaired Increase in dead space Impaired oxygen diffusion Hypoxemia Increased pulmonary artery pressure Right sided heart failure Increased carbon dioxide tension in arterial blood Respiratory acidosis

Signs and Symptoms

Shortness of breath Cough Wheezing "Pursed-lipped breathing." Cyanosis Barrel chest

Diagnostic Procedures
Chest X-Ray:
**hyperinflation

Pulmonary Function Tests: Spirometry (to evaluate airflow obstruction, to determine the reversibility of obstruction after use of bronchodilators) Family history of alpha-1-antitrypsin deficiency Blood tests may also be used to check white blood cell count, which can sometimes indicate an acute infection. Arterial Blood Gases: to determine baseline oxygenation and gas exchange CT Chest Scan & Sputum exam: for differential diagnosis

Diagnostic Procedures
Chest X-Ray:
**hyperinflation

Pulmonary Function Tests:

Spirometry (to evaluate airflow obstruction, to determine the reversibility of obstruction after use of bronchodilators)

Family history of alpha-1-antitrypsin deficiency Blood Tests:

may also be used to check white blood cell count, which can sometimes indicate an acute infection.

Arterial Blood Gases:

to determine baseline oxygenation and gas exchange

CT Chest Scan & Sputum Exam:

for differential diagnosis

Nursing Care Management

If ordered, perform chest physiotherapy, including postural drainage and chest percussion and vibration several times daily. Educate on importance of healthy lifestyle and environment modification on respiratory status Schedule respiratory treatments at least 1 hour before and after meals. Provide high calorie-protein rich diet to promote health and healing. Encourage daily activity and provide diversionary activities as appropriate. Make sure the patient receives adequate fluids at least 3 liters per day to loosen secretions.

 Administer medications as ordered and record the patients response. Monitor the patients respiratory function regularly. Monitor the patients RBC count for increases (warning signs of increasing lung and vascular congestion). Watch for complications, such as respiratory tract infections, cor pulmonale, spontaneous pneumothorax, respiratory failure, and peptic ulcer disease. Include the patient and his family in care-related decision. Provide supportive care, and help the patient adjust to lifestyle changes imposed by a chronic illness.

Pharmacological Management
Bronchodilators
Albuterol (Proventil or Ventolin) Ipratropium bromide (Atrovent) Methylxanthines (Theophylline)

Corticosteroids Antibiotics Oxygen Nutritional supplements

BROCHIECTIASIS

What is Bronchiectiasis?
It is a condition in which damage to the airways causes them to widen and become flabby and scarred.

Risk Factors
Age Men Cigarette Smoking Serious lung infection Long standing cystic fibrosis

Pathophysiology
1. Infection of the small airways 2. Leads to the release of inflammatory mediators such as proteases which damage the large airways resulting in bronchial dilation 3. Infection drives progressive inflammation in the small airways which become thicker from a combination of cell-mediated inflammatory infiltrate and lymphoid follicles resulting in obstruction 4. The final process involves the spread of inflammation beyond the airways resulting in interstitial pneumonia

Signs and Symptoms

Chronic productive cough Tachypnea* Shortness of breath on exertion Tachypnea Chronic headaches Halitosis

Diagnostic Procedures
Chest X-Ray:
**hyperinflation

Pulmonary Function Tests:

Spirometry (to evaluate airflow obstruction, to determine the reversibility of obstruction after use of bronchodilators)

Arterial Blood Gases:

to determine baseline oxygenation and gas exchange

CT Chest Scan & Sputum Exam:

for differential diagnosis

Nursing Care Management

Encourage smoking cessation Educate on importance of healthy lifestyle and environment modification on respiratory status Encourage adequate fluid intake for expulsion of sputum Provide and educate on appropriate chest therapy: postural drainage, percussion, breathing exercises

Pharmacological Management
Bronchodilators Oxygen (for hypoxia) Antibiotics