Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Emphysema Abnormal...

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

EmphysemaEmphysema

• Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli

• Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion.

• Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures.

• Hypoxemia is the result of these pathologic changes.

• Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale).


Changes in Alveolar Structure with Emphysema Changes in Alveolar Structure with Emphysema


Normal Chest Wall and Chest Wall Changes with EmphysemaNormal Chest Wall and Chest Wall Changes with Emphysema


Typical Posture of a Person with COPDTypical Posture of a Person with COPD


Risk Factors for COPDRisk Factors for COPD

• Tobacco smoke causes 80-90% of COPD cases!

• Passive smoking

• Occupational exposure

• Ambient air pollution

• Genetic abnormalities

– Alpha1-antitrypsin


Pathophysiology of COPDPathophysiology of COPD• Airflow limitation is progressive and is associated with

abnormal inflammatory response of the lungs to noxious

agents.

• Inflammatory response occurs throughout the airways,

lung parenchyma, and pulmonary vasculature.

• Scar tissue and narrowing occur in airways.

• Substances activated by chronic inflammation damage

the parenchyma.

• Inflammatory response causes changes in pulmonary

vasculature.


Nursing Process: The Care of Patients with COPD: AssessmentNursing Process: The Care of Patients with COPD: Assessment

• Health history

• Inspection and exam findings

• See Chart 24-2 and Chart 24-3

• Review of diagnostic tests


Nursing Process: The Care of Patients with COPD: DiagnosisNursing Process: The Care of Patients with COPD: Diagnosis

• Impaired gas exchange

• Impaired airway clearance

• Ineffective breathing pattern

• Activity intolerance

• Deficient knowledge

• Ineffective coping


Collaborative ProblemsCollaborative Problems

• Respiratory insufficiency or failure

• Atelectasis

• Pulmonary infection

• Pneumonia

• Pneumothorax

• Pulmonary hypertension


Nursing Process: The Care of Patients with COPD: PlanningNursing Process: The Care of Patients with COPD: Planning

• Smoking cessation

• Improved activity tolerance

• Maximal self-management

• Improved coping ability

• Adherence to therapeutic regimen and home care

• Absence of complications


Improving Gas ExchangeImproving Gas Exchange

• Proper administration of bronchodilators and corticosteroids

• Reduction of pulmonary irritants

• Directed coughing, “huff” coughing

• Chest physiotherapy

• Breathing exercises to reduce air trapping

– Diaphragmatic breathing

– Pursed-lip breathing

• Use of supplemental oxygen


Improving Activity ToleranceImproving Activity Tolerance

• Focus on rehabilitation activities to improve ADLs and promote independence.

• Pacing of activities

• Exercise training

• Walking aids

• Use a collaborative approach.


Other InterventionsOther Interventions

• Set realistic goals.

• Avoid extreme temperatures.

• Enhance coping strategies.

• Monitor for and manage potential complications.


Patient TeachingPatient Teaching

• Disease process

• Medications

• Procedures

• When and how to seek help

• Prevention of infections

• Avoidance of irritants; indoor and outdoor pollution and occupational exposure

• Lifestyle changes, including cessation of smoking


QuestionQuestion

COPD is the ____ leading cause of death in the United States.

a.First

b.Second

c.Third

d.Fourth


Chronic BronchitisChronic Bronchitis

• The presence of a cough and sputum production for at least 3 months in each of 2 consecutive years

• Irritation of airways results in inflammation and hypersecretion of mucus.

• Mucus-secreting glands and goblet cells increase in number.

• Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucus may plug airways.

• Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes.

• The patient is more susceptible to respiratory infections.


Pathophysiology of Chronic BronchitisPathophysiology of Chronic Bronchitis


AsthmaAsthma

• A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production

• Inflammation leads to cough, chest tightness, wheezing, and dyspnea.

• The most common chronic disease of childhood

• Can occur at any age

• Allergy is the strongest predisposing factor.


Pathophysiology of AsthmaPathophysiology of Asthma


Medications Used for AsthmaMedications Used for Asthma

• Quick-relief medicationsSee Table 24-2

– Beta2-adrenergic agonists

– Anticholinergics

• Long-acting medicationsSee Table 24-4

– Corticosteroids

– Long-acting beta2-adrenergic agonists

– Leukotriene modifiers


QuestionQuestion

Which of the following is a methylxanthine bronchodilator?

a. Aminophylline

b. Atrovent

c. Maxair

d. Proventil


Examples of Metered-Dose Inhalers and SpacersExamples of Metered-Dose Inhalers and Spacers


Patient TeachingPatient Teaching

• The nature of asthma as a chronic inflammatory disease

• Definition of inflammation and bronchoconstriction

• Purpose and action of each medication

• Identification of triggers and how to avoid them

• Proper inhalation techniques

• How to perform peak flow monitoring

• How to implement an action plan

• When and how to seek assistance


Using a Peak Flow MeterUsing a Peak Flow Meter

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Emphysema Abnormal...

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