COPD Pathology Window

Instructions: One pathology window must be submitted with the pre-work paperwork. The student should select the main disease process for the assigned client, research the disease in an appropriate text, and then complete the pathology window by filling in the required areas. Be brief and concise. An example of a complete pathology window will be issued to the students for a reference. The reference text should be cited below in APA format.

Assessment
VS with AP Respiratory rate and pattern, cough and secretions (COCA). Breath sounds. Nutritional status; diet history, BMI, skin fold measurements. Skin color and turgor. Capillary refill on fingers and toes. Shape of chest and accessory muscle use. O2 sats. Anxiety level.

Signs and Symptoms

Manifestations are typically absent or minor in the early stages of the disease. Productive cough, typically in the morning. Dyspnea on exertion, progressing to severe dyspnea at rest, exercise intolerance, wheezing, barrel chest, prolonged expiration, cyanosis, chronic hypoventilation, polycythemia and tripod breathing.

Medications
Antihistamines, sympathomimetic, bronchodilator, anti-inflammatories, Corticosteroid, expectorant, antibiotics, antidepressants and anti-anxiety. Cessation of smoking is imperative so nicotine patches, gum might be Rx. Patients should also get yearly pneumococcal pneumonia and influenza vaccine.

Nursing Interventions
Place in high Flowers position. Encourage fluid intake (2000-25000), coughing and deep breathing q2h while awake, assist with postural drainage/percussion as needed. Suction as necessary. Provide for rest between treatments. Correlate timing of expectorant/bronchodilator with respiratory treatments. Admin meds and O2 as ordered. Consult with nutrition to insure calorie needs are met. Plan a course of action to quit smoking. Teach pursed-lip and diaphragmatic breathing. Teach controlled and huff coughing. Instruct on avoiding irritants, infection, and yearly vaccine importance. Seek medical attention at early signs of exacerbation. Teach to wear medical alert tag.

Disease Definitions
Chronic obstructive pulmonary disease (COPD)-is a progressive syndrome that includes pathogenic lung changes consistent with emphysema or chronic bronchitis. It is characterized by abnormal test of expiratory airflow that does not change markedly over time nor exhibit major reversibility in response to pharmacologic agents. Is also associated with an abnormal inflammatory response of the lungs to noxious particles/gases. It is more common in whites and men and is the 4th leading cause of death in the US.

Pathophysiology
Irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into bronchial wall. Continual inflammation leads to bronchial edema and an increase in size and number of mucosal glands and goblet cells in the airway epithelium. Thick mucus is produced and cannot be cleared because of impaired ciliary function. The lung defenses are compromised increasing the patient to susceptibility to pulmonary infection/injury. Frequent infectious exacerbations are complicated by bronchospasm with dyspnea and productive cough. As disease progresses both large and small airways become involved. As airways narrow, expiratory airway obstruction results, trapping gas in distal portions of the lung. Ventilation-profusion mismatch and hypoxia occur. Extensive trapping puts the respiratory muscles at a mechanical disadvantage, resulting in hypoventilation and hypercapnia.

Labs
CBC with diff ABG Serum alpha 1-antitrypsin levels screening, sputum and blood cultures for possible infection.

Diagnostic tests
Pulmonary function test Ventilation/ perfusion scanning Capnogram or ETCO2 Chest x-ray ECG

Nutrition
Maintain fluid and nutrient intake. Small meals and nutritional supplement. Diet high in protein and good fats without excess carbohydrates

Huether, S., & McCance, K. (2008). Understanding pathophysiology. (4 ed., pp. 729-729).St Louis, MO:Mosby Elsevier. LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-surgical nursing critical thinking in patient care. (5 ed., pp. 1239-1249). NEW JERSEY: Pearson. McCance, K. L., & Huether, S. E. (2010). Pathophysiology, the biologic basis for disease in adults and children. (6th ed., p. 689). Maryland Heights, Missouri: Mosby. McPhee, S. J., Lingappa, V. R., & Ganong, W. F. (2003). Pathophysiology of disease:an introduction to clinical medicine. (4 ed., p. 185190). New York, NY: McGraw-Hill.