Respiratory Module

1. Respiratory Module C.O.P.D.

2. COPD - overview COPD? • Chronic Obstructive Pulmonary Disease • COLD? • Chronic Obstructive Lung Disease • Broad classifications of disease

3. COPD • Characterized by • airflow limitation • Irreversible • Dyspnea on exertion • Progressive • Abn. inflammatory response of the lungs to noxious particles or gases

4. Pathophysiology • Noxious particles of gas  • Inflammatory response  • (occurs throughout the airways, parenchyma and pulmonary vasculature) • Narrowing of airway

5. Pathophysiology • Injury  Repair • Injury  repair • Injury  repair • Injury  Repair • Injury  repair  scar tissue  • Narrowing of lumen

6. Pathophysiology • Inflammation  • Thickening of the wall of the pulmonary capillaries • (Smoke damage & inflammatory process)

7. COPD • Includes • Emphysema • Chronic bronchitis • Does not include • Bronchiectasis • Asthma

8. COPD - FYI • COPD 4th leading cause of death in the US • 12th leading cause of disability • Death from COPD is on the rise while death from heart disease is going down

9. COPD Risk Factors for COPD • Exposure to tobacco smoke • 80-90% of COPD • Passive smoking • Occupational exposure • Air pollution

10. COPD risk factors • #1 • Smoking • Why is smoking so bad?? • ↓ scavenger cell ability • ↓ cilia function • Irritates goblet cells & Mucus glands  • ↑ mucus production

11. Chronic Bronchitis • Disease of the airway • Definition: • cough + sputum production • > 3 months • 2 consecutive years

12. Chronic Bronchitis Pathophysiology • Pollutant irritates airway  • Inflammation + h secretion of mucus  • h goblet cells + • h mucus secreting glands + h Mucus • i ciliary function

13. Chronic Bronchitis • Plugs become areas for bacteria to grow and chronic infections which increases mucus secretions and eventually, areas of focal necrosis and fibrosis

14. Chronic Bronchitis • Bronchial walls thicken • Bronchial Lumen narrows • Mucus plugs airway • Alveoli/bronchioles become damaged • ↑ alveolar macrophages  • ↑ susceptibility to LRI

15. What do you think? Exacerbation of Chronic bronchitis is most likely to occur during? • Fall • Spring • Summer • Winter

16. Emphysema Pathophysiology • Affects alveolar membrane • Destruction of alveolar wall • Loss of elastic recoil • Over distended alveoli

17. Emphysema Pathophysiology • Over distended alveoli • Damage to adjacent pulmonary capillaries • h dead space • Impaired passive expiration •  Impaired gas exchange

18. Emphysema • Impaired gas exchange • impaired expiration • Hypoxemia • h CO2  • Hypercapnia • Respiratory acidosis

19. Emphysema • Damaged pulmonary capillary bed • h pulmonary pressure  • h work load for right ventricle  • Right side heart failure (due to respiratory pressure)  • Cor Pulmonale

20. COPD Compare and contrast • Chronic Bronchitis is a disease of the ___________? • Airway • Emphysema is a disease affecting the ___________? • Alveoli

21. C.O.P.D. • Risk factors, S&S, treatment, Dx, Rx - same for Chronic Bronchitis & Emphysema

22. C.O.P.D. Clinical Manifestation (primary) • Cough • Sputum production • Dyspnea on exertion (Secondary) • Wt. loss • Resp. infections • Barrel chest

23. C.O.P.D.Nrs. Assessment • Risk factors • Past Hx / Family Hx • Pattern of development • Presence of comobidities • Current Tx • Impact

24. C.O.P.D.Diagnostic exams/procedures • Pulmonary function test • Tidal Volume • i • Functional residual • h • Spirometry / FEV (force of expired vol.) • i

25. C.O.P.D.Diagnostic exams/procedures • Bronchodilator reversibility test • Check FEV • Give Bronchodilator • If improved FEV = Asthma • If no improvement FEV = COPD

26. ABG’s • Baseline PaO2 • Rule out other diseases • CT scan • X-ray

27. C.O.P.D. Medical Management • Risk reduction • Smoking cessation! • (The only thing that slows down the progression of the disease!)

28. C.O.P.D. Rx. therapy Primary • Bronchodilators • Corticosteriods Secondary • Antibiotics • Mucolytic agents • Anti-tussive agents

29. Bronchodilators • Action: • Relieve bronchospasms • Reduce airway obstruction • ↑ ventilation • Route • Metered-dose inhaler • Nedulizer • Oral

30. Bronchodilators • Frequency • Regularly throughout the day • & PRN • Prophylactically

31. Bronchodilators • Examples • Albuterol (Proventil, Ventolin, Volmax) • Metaproterenol (Alupent) • Ipratropium bromide (Atrovent) • Theophylline (Theo-Dur)* * Oral

32. Glucocorticoids • Action • Potent anti-inflammatory agent • Route • Inhaled • Systemic • (oral or intravenous)

33. Endocrine Flashback Which of the following is an iatrogenic event secondary to prolonged use of corticosteroid medications? • SIADH • Diabetes Insipidus • Cushing disease • Addison’s disease • Acromegaly

34. What electrolyte imbalance is assoc with Cushing Syndrome? • Hypercalcemia • Hypocalcemia • Hypernatremia • Hyponatremia • Hyperkalemia • Hypokalemia

35. Corticsteriods • S/E • Cushing • Moon face • Na+ & H20 retention • Never discontinue abruptly

36. What affect do corticosteroids have of blood sugar levels?

37. Glucocorticoids • Examples • Prednisone • Methyprednisone • Beclovent

38. C.O.P.D. Medical Management • Treatment • O2 • When PaO2 < 60 mm Hg • Pulmonary rehab • Breathing exercises • Pulmonary hygiene

39. Nursing Management • Impaired gas exchange • Ineffective airway clearance • Ineffective breathing patterns • Activity intolerance • Deficient knowledge about self-care • Ineffective coping

40. Nursing Management • Impaired gas exchange • Bronchodilators • Corticosteroids • Monitor for side effects • Measure FEV (force of expired volume) • Assess dyspnea • Smoking cessation

41. Nursing Management • Ineffective airway clearance • Eliminate pulmonary irritants • Directed cough • Chest physiotherapy • Fluids • Aerosol mists

42. Nursing Management • Ineffective breathing patterns • Teach and encourage breathing exercises…

43. Nursing Management • Breathing exercises • (usually have shallow, rapid, inefficient breathing) • Diaphragmatic breathing  • ↓rate • ↑ventilation • ↑expelled air • Pursed lip breathing • Slows respiration • Prevents collapse of small airways • Helps control rate and depth • Relax (↓ anxiety)

44. Nursing Management • Activity intolerance • Activity pacing • More fatigued in AM • Plan activities for “best times” • Physical conditioning • Exercise training • ↑tolerance • ↓dyspnea • ↓fatigue • Graded exercise • Regular vs. sporadic

45. Nursing Management • Deficient knowledge about self-care • ↑participation (ĉ ↑ improvement) • Coordinate diaphragmatic breathing with activities • Avoid fatigue • Fluids always available

46. Knowledge Deficit • O2 therapy • Flow rate • # hours required • No smoking • Regular blood oxygenation levels • Regular ABG’s

47. Knowledge Deficit • Set realistic goals • Modify life style • Avoid temperature extremes • Heat  • ↑ O2 demand • Cold  • ↑ bronchospasms

48. Nursing Management • Ineffective coping • Set realistic goals • Listen • Empathy • Refer

49. C.O.P.D.Nursing Management • Imbalanced Nutrition: Less than Body requirement • (frequently weight loss and protein breakdown) • Monitor weight • ↑Protein • Nutritional supplements

50. Question? A patient is getting discharged from a SNF facility. The patient has a history of severe COPD and PVD. The patient is primarily concerned about their ability to breath easily. Which of the following would be the best instruction for this patient? A.  Deep breathing techniques to increase O2 levels. • Cough regularly and deeply to clear airway passages. • Cough following bronchodilator utilization • Decrease CO2 levels by increase oxygen tank output during meals.