COPD.ppt

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CHRONIC OBSTRUCTIVE PULMONARY DISEASE:

CHRONIC OBSTRUCTIVE PULMONARY DISEASE Conducted by: Ms.Monika Clinical instructor Army college of nursing

INTRODUCTION:

INTRODUCTION COPD is a group of disease characterized by the pathological limitation of airflow in the airway that is not fully reversible. which refers to several disorders that affect the movement of air in & out of the lungs.

CONT..:

CONT.. It mainly consist of two disease that is emphysema and chronic Bronchitis.

DEFINITION:

DEFINITION CHRONIC BRONCHITIS : chronic Inflammation of lower respiratory tract characterized by excessive mucus secretion, cough and dyspnea.

CONT..:

CONT.. EMPHYSEMA : It is the condition of Impaired gas exchange result from destruction of walls of over distend alveoli. 1) panlobular 2) centriolar

ETIOLOGY:

ETIOLOGY Cigarette smoking Occupational exposure Infection Old age Air pollution Allergy Genetic predisposition

Pathophysiology:

4/30/2011 10 Pathophysiology a) Excessive secretion of mucus & chronic infection within airways , irritation, hypersensitivity Hypertrophy of mucus glands Increase in size & number of mucus –producing elements in bronchi Inflammation & edema Narrowing & obstruction of airflow

Clinical manifestation:

4/30/2011 11 Clinical manifestation Chronic bronchitis : -Productive cough for 3 months in a year. -Thick,gelatinous sputum in greater amounts -Wheezing & dyspnea as disease progresses. Barrel chest Weight loss

Cont…:

4/30/2011 12 Cont… Emphysema: - Dyspnea . - Decreased exercise tolerance. - Cough may be minimal, except with respiratory infection. - Mild sputum expectoration. - Barrel chest due to air trapping with diaphragmatic flattening.

DIAGNOSIS:

DIAGNOSIS History and Examination Arterial blood gas Sputum Examination Pulmonary Function Test ABG levels: - decreased PaO2 , PH, & increased CO2. Chest X- ray: hyper inflation ,possible bullae.

Cont…:

4/30/2011 14 Cont… Emphysema: - Dyspnea . - Decreased exercise tolerance. - Cough may be minimal, except with respiratory infection. - Mild sputum expectoration. - Barrel chest due to air trapping with diaphragmatic flattening.

Complications:

4/30/2011 15 Complications Respiratory failure. Pneumonia , over whelming respiratory infection. Right-sided heart failure , dysrhythmias. Depression. Skeletal muscle dysfunction.

Slide 16:

4/30/2011 16 MEDICAL MANAGEMENT

Management:

4/30/2011 17 Management Goal: To reverse airflow obstruction. Smoking cessation. Inhaling bronchodilators. It is delivered by metered dose inhalers or hand held or mask held devices. a) Anticholinergics (ipratropium) b)Short-acting beta-adrenergic agonists (albuterol) c)Long-acting beta-adrenergic agonists (salmeterol)

Cont…:

4/30/2011 18 Cont… 4)Corticosteroids (inhaled & oral) 5)Chest-physiotherapy 6)Supplemental O2 therapy 7)Antimicrobial agents for episodes of respiratory infections.

SURGICAL MANAGEMENT:

SURGICAL MANAGEMENT Bullectomy Lung volume reduction lung transplantation

Bullectomy :

Bullectomy A bullectomy is the surgical removal of a bulla , or a thick-walled air space, that can be caused by emphysema , infection, or a congenital defect.. A bulla's size may vary, but they are generally between .25 inches (.635 cm) and .5 inches (1.27 cm). A surgeon may remove bullae from the lungs to encourage the healthy air sacs around it to expand, and allow the lung to function at a more efficient level

Cont…………..d:

Cont…………..d

BEHAVIORAL THERAPY:

BEHAVIORAL THERAPY Nutrional therapy Smoking cessation

Slide 23:

4/30/2011 23 NURSING MANAGEMENT

Nursing management:

4/30/2011 24 Nursing management Nursing assessment: 1. Determine smoking history, exposure history ,+ve family history of respiratory disease ,onset of dyspnea. 2. Note amount , color &consistency of sputum. 3. Inspect for use of accessory muscles of respiration & use of abdominal muscles during expiration ; Note increase of anteroposterior diameter of chest.

Cont…:

4/30/2011 25 Cont… 4. Auscultate for decreased / absent breath sounds , crackles , decreased heart sounds. 5. Determine level of dyspnea , how it compares to patients baseline. 6. Determine O2 saturation at rest & with activity.

Cont…:

4/30/2011 26 Cont… Nursing diagnose : Ineffective airway clearance r/t bronchoconstriction , increased mucus production ,ineffective cough , possible bronchopulmonary infection. Goal : Improving airway clearance

Cont…:

4/30/2011 27 Cont… Nursing interventions : Eliminate pulmonary irritants , particularly cigarette smoking. Administer bronchodilator to control bronchospasm & dyspnea & assist with raising sputum. Use postural drainage positions to aid for airway obstruction.

Cont…:

4/30/2011 28 Cont… Use controlled coughing. Keep secretions liquid. Avoid dairy foods if these increase sputum production.

Cont…:

4/30/2011 29 Cont… Nursing diagnose :Ineffective breathing pattern r/t compromised defense mechanisms. Goal :Improving breathing pattern.

Cont…:

4/30/2011 30 Cont… Nursing interventions : Teach & supervise retraining exercise to strengthen diaphragm & muscles of expiration to decrease of breathing. Discuss & demonstrate relaxation exercises to reduce stress , tension & anxiety. Encourage patient to assume position of comfort to decrease dyspnea. Controlling infection.

Cont…:

4/30/2011 31 Cont… Nursing diagnose :Impaired gas exchange r/t chronic pulmonary obstruction V/Q abnormalities due to destruction of alveolar capillary membrane. Goal :Improving gas exchange.

Cont…:

4/30/2011 32 Cont… Nursing interventions : Watch for & report excessive somnolence , restlessness , aggressiveness , anxiety or confusion . Review ABG levels , record values on a flow sheet so comparisons can be made over time. Monitor O2 saturation & give supplemental O2 as ordered to correct hypoxemia in a controlled manner.

Cont…:

4/30/2011 33 Cont… Be prepared to assist with non-invasive ventilation or intubation & mechanical ventilation if acute respiratory failure & rapid Co2 retention occur.

Cont…:

4/30/2011 34 Cont… Nursing diagnose : Imbalanced nutrition less than body requirement r/t increased work of breathing , air swallowing , drug effects with resultant wasting of respiratory & skeletal muscles. Goal: Improving nutrition.

Cont…:

4/30/2011 35 Cont… Nursing interventions : Take nutritional history , weight & anthropometric measurements. Encourage frequent small meals if patient is dyspneic . Encourage snaking on high-calorie , high protein snacks. Offer liquid nutritional supplements to improve calorie intake & counteract weight loss.

Cont…:

4/30/2011 36 Cont… Avoid food producing gas & abdominal discomfort. Employ good oral hygiene before meals to sharpen taste sensation. Encourage pursed-lip breathing. Give supplemental O2 while patient is eating to relieve dyspnea as directed Monitor body weight.

Cont…:

4/30/2011 37 Cont… Nursing diagnose : Activity intolerance r/t compromised pulmonary function , resulting in shortness of breath & fatigue. Goal: Increasing activity tolerance.

Cont…:

4/30/2011 38 Cont… Nursing intervention : Re-emphasize the importance of graded exercise & physical conditioning programs. Encourage patient to carryout regular exercise program 3-7 days per week to increase physical endurance. Train patient in energy conservation techniques.

Cont…:

4/30/2011 39 Cont… Nursing diagnose :Ineffective coping r/t the stress of living with chronic disease , loss of independence. Goal :Enhancing coping.

Cont…:

4/30/2011 40 Cont… Nursing interventions : Understand that constant shortness of breath & fatigue make the patient anxious & depressed. Assess the patient for reactive behaviors ( anger, depression , acceptance) . Demonstrate a positive & interested approach to the patient.

Cont…:

4/30/2011 41 Cont… Strengthen the patients self-image. Allow patient to express feelings. Support family members.

Patient education.:

4/30/2011 42 Patient education. Avoid exposure to respiratory irritants Prevent & treat respiratory infections. Reduce bronchial secretions. Improve airflow. Breathing exercises.

General health.:

4/30/2011 43 General health. Teach good habits of well-balanced nutritious intake. Encourage high-protein with adequate mineral , vitamin & fluid intake. Advice against excessive hot or cold foods , which may provoke an irritating cough. Advice to avoid hard-to-chew foods & gas-forming foods.

Cont…:

4/30/2011 44 Cont… Encourage 5 to 6 small meals daily to ease shortness of breath during & after meals. Suggest rest periods before & after meals if eating produces shortness of breath.

Slide 45:

Thanks