DISEASE SPECIFIC INFORMATION DISEASE/DEFINITION COPD: Chronic Obstructive Pulmonary Disease- a preventable & treatable disease state that

is characterized by airflow limitation that is not fully reversible. PATHOPHYSIOLOGY The hallmark of COPD is chronic inflammation that affects central airways, peripheral airways, lung parenchyma and alveoli, and pulmonary vasculature. The main components of these changes are narrowing and remodeling of airways, increased number of goblet cells, enlargement of mucus-secreting glands of the central airways, and, finally, subsequent vascular bed changes leading to pulmonary hypertension. This is thought to lead to the pathologic changes that define the clinical presentation. Tobacco smoking is by far the main risk factor for COPD. It is responsible for 90% of COPD cases and exerts its effect by causing an inflammatory response, cilia dysfunction, and oxidative injury. Air pollution and occupational exposure are other common etiologies. CLINICAL MANIFESTATIONS (SIGNS AND SYMPTOMS) - cough, sputum production, or dyspnea, and/or a history of exposure to risk factors for the disease. - Chronic intermittent cough usually occurring in the morning and may or may not be productive of small amounts of sticky mucus. In late stages, dyspnea may be present at rest. COMPLICATIONS Cor pulmonale- results from pulmonary hypertension caused by constriction of pulmonary vessels in response to alveolar hypoxia with acidosis further potentiating the vasoconstriction. - Right-sided heart failure, respiratory depression, recurrent pneumonia, COPD exacerbations COMMON TREATMENT - Smoking cessation - O2 therapy - Corticosteroids: oral for exacerbations; inhaled for maintenance - Breathing exercises - Bronchodilator therapy: B2-adrenergic agonists, anticholinergic agents, long-acting Theophylline preparations - Hydration of 3 L/day - Airway clearance techniques - Nutritional supplementation (if low BMI) DIAGNOSTICS History and Physical examination - Chest x-ray - Serum a1-antitrypsin levels - 6-minute walk test - Pulmonary function tests - ABGs TEACHING NEEDS Wash nasal cannula with a liquid soap and thoroughly rinse once or twice a week; replace cannula Q2-4 weeks - Always remove secretions that are coughed out - Post No Smoking warning signs outside the homes - Oxygen will not blow up, but it will increase the rate of burning; it is a fuel for the flame/fire - Do not allow smoking in the home and do not smoke yourself while wearing O2. Effective coughing: huff cough COMMON NURSING INTERVENTIONS Assist pt. to sitting position with head slightly flexed, shoulders relaxed, and knees flexed. - Instruct pt. to inhale deeply, bend forward slightly, and perform 3 or 4 huffs to prevent airway collapse during exhalation. - Instruct pt. to follow coughing with several maximal inhalation breaths to reoxygenate the lungs. - Administer supplemental oxygen as ordered. - Monitor the effectiveness of oxygen therapy (e.g., pulse oximetry, ABGs) to evaluate pt. response to therapy. REFERENCE: PAGE NUMBER FOR LEWIS. FULL TITLE, AUTHOR, AND PAGE NUMBER FOR OTHER SOURCES Medical-Surgical Lewis Pages 610 627