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ISSUES IN OBESITY, PART 2

42 l Nursing2011 l November www.Nursing2011.com

Copyright © 2011 Lippincott Williams & Wilkins.

Unauthorized reproduction of this article is prohibited.

7/17/2019 Document(1)


Obesityweighs heavily on lung function

D A N E G E R

/ I S T O C K P H O T O

By RobinLawson,DN, an!Bill ruitt,"B#,RR$, #%&', '($

7/17/2019 Document(1)


OBESITY IS A SERIOUS and growing peror!an"e# Sign$ and $%!p&o!$ o

'ea(&' "on"ern in &'e Uni&ed S&a&e$# &'e$e pro)(e!$ &end &o wor$en w'en

2.3In *++*, no $&a&e 'ad an o)e$i&% ra&e a pa&ien& w'o$ o)e$e i$ $-pine#

.

grea&er &'an 20# Now, ad-(& o)e$i&% Co!p(e&e p-(!onar% -n"&ion #N''

ra&e$ are o1er 20 in !ore &'an &wo3 &e$&ing 4!ea$-ring $piro!e&r%, (-ng'ON$#'$ )O*R+

&'ird$ o $&a&e$, and o1er *2 !i((ion 1o(-!e$, and di-$ion5 o&en $'ow$

ado(e$"en&$ and "'i(dren are o)e$e#*

a re$&ri"&i1e di$ea$e pa&&ern wi&'

T'e CDC deine$ o)e$i&% in ad-(&$ de"rea$ed e6pira&or% re$er1e 1o(-!ea$ a )od% !a$$ inde6 4B7I5 o 8 or 4ER95 and -n"&iona( re$id-a( "apa"i&%

'ig'er, a$ "a("-(a&ed wi&' &'i$ or!-(a: 4;RC5# ;or !ore inor!a&ion on p-(3

B7I < weig'& 4=g5/>'eig'& 4!5?2

!onar% -n"&ion &e$&ing, $ee '&&p://;or -r&'er "(a$$ii"a&ion$, $ee Clas- www#n(!#ni'#go1/!ed(inep(-$/en"%/

sifying by BMI #2

ar&i"(e/8@8#'&!# 4A($o $ee GuideCer&ain ra"ia( and e&'ni" gro-p$ to respiratory abbreviations#5

'a1e a 'ig'er pre1a(en"e o o)e$i&% To&a( (-ng "apa"i&% 4TC5 and

or e6a!p(e, B(a"= and Hi$pani" re$id-a( 1o(-!e 4R95 are !ain&ained

A!eri"an$, &'o$e w'o (i1e in $o-&'3 e6"ep& in "a$e$ o e6&re!e o)e$i&%,

ern $&a&e$, and &'o$e ro! (ower w'ere TC and R9 de"rea$e a$ weig'&

$o"ioe"ono!i" )a"=gro-nd$#* 7an% in"rea$e$# 7o$& pa&ien&$ !ain&ain a

'ea(&' pro)(e!$ are (in=ed &o o)e$i&%, nor!a( or"ed e6pired 1o(-!e in one

in"(-ding a$&'!a, "'roni" o)$&r-"&i1e $e"ond/or"ed 1i&a( "apa"i&% ra&io p-(!onar% di$ea$e 4COPD5, and 4;E9*/;9C5 in &'e a)$en"e o o&'er

$(eep apnea#8 T'i$ ar&i"(e e6p(ore$ &'e (-ng di$ea$e#

., P-(!onar% ga$

i!pa"& o o)e$i&% on ea"' o &'e$e e6"'ange 4indire"&(% a$$e$$ed )%

di$order$# S&ar& )% "on$idering 'ow !ea$-ring &'e di-$ion in &'e (-ng

o)e$i&% ae"&$ &'e re$pira&or% $%$&e!# o "ar)on !ono6ide >DCO?5 !a%

Understanding how obesity

)e nor!a( or in"rea$ed#

O)e$i&% i!pair$ 1en&i(a&or% -n"3

alters lung function &ion in $e1era( wa%$# A$ B7I ri$e$,

A(&era&ion$ in &'e p-(!onar% $%$&e! &%pi"a((% a(( (-ng 1o(-!e$ are red-"ed

(in=ed &o o)e$i&% in"(-de a)nor!a(i3 w'i(e e6pira&or% air(ow re!ain$ nor3

&ie$ in 1en&i(a&or% !e"'ani"$ and !a(# 7e"'ani"a( ee"&$ o o)e$i&% on

!-$"(e -n"&ion, 1en&i(a&or% "on&ro(, &'e diap'rag! and "'e$& wa(( (ead

p-(!onar% ga$ e6"'ange, and "ardia" &o i!paired diap'rag!a&i" e6"-r$ionwww.Nursing2011.com November l

Nursing2011 l 43

Copyright ©

2011 Lippincott

Williams & Wilkins.

Unauthorized reproduction of

this article is prohibited.

and red-"ed &'ora"i" "o!p(ian"e#

A""ording &o &'e Na&iona( Hear&,

-ng, and B(ood In$&i&-&e, $"reening

or a per$on$ ri$= o de1e(oping

o)e$i&%3re(a&ed di$ea$e in"(-de$

"a("-(a&ing &'e B7I, de&er!ining i

o&'er "ondi&ion$ a$$o"ia&ed wi&' o)e3

$i&% 4$-"' a$ a $eden&ar% (ie$&%(e or'%per&en$ion5 e6i$&, and !ea$-ring

wai$& "ir"-!eren"e &o a$$e$$ or

a)do!ina( a&, w'i"' predi"&$ &'e ri$=

o o)e$i&%3a$$o"ia&ed di$ea$e$# T'e

ri$= in"rea$e$ or !en wi&' a wai$&

"ir"-!eren"e (arger &'an . in"'e$

and wo!en wi&' a wai$& "ir3

"-!eren"e (arger &'an 8 in"'e$#8

;a"&or$ $-"' a$ gender, ra"e, age,

and 'eig'& are &%pi"a((% "on$idered

w'en in&erpre&ing p-(!onar% -n"&ion

&e$& re$-(&$# Howe1er, &'e$e p-(!o3

nar% -n"&ion &e$& re$-(&$ !a% no& )ea""-ra&e indi"a&or$ or o)e$e pa&ien&$

)e"a-$e nor!a( predi"&ed 1a(-e$ or

$piro!e&r%, (-ng 1o(-!e$, and DCO

-$-a((% aren& "orre"&ed or weig'&#.,

E1en &'o-g' weig'& i$n& nor!a((%

"on$idered w'en predi"&ing (-ng 1a(3

-e$, pra"&i&ioner$ !-$& =eep in !ind

&'a& &'e !-$"-(ar eor& re-ired &o

$-ppor& 1en&i(a&ion a& re$& and d-ring

e6er"i$e i$ grea&er in a pa&ien& w'o$

o)e$e &'an in one o nor!a( weig'&#

T'i$ in"rea$ed !-$"-(ar eor& i$ d-e!ain(% &o &'e 'ig'er 1en&i(a&or%

re-ire!en& )ro-g'& on )% an

in"rea$ed !e&a)o(i" de!and and &'e

in"rea$ed !e"'ani"a( (oading o &'e

!-$"(e$ -$ed d-ring in$pira&ion#.

e&$ e6p(ore 'ow o)e$i&% and

de"rea$ed (-ng -n"&ion are a$$o"ia&ed

wi&' a$&'!a, COPD, and $(eep apnea#

Classifying by BMI

Classification BMI

*n!erweight 1-.

Normal 1-./2.

Overweight 2.0/2.

Obesity 'lass 30.0/3.

Obesity 'lass 3.0/3.

%4treme Obesity ≥0

+ource5 'enters for Disease 'ontrol an! reven&tion. Obesity an! overweight for 6rofessionals5health conse7uences. 2011. htt6588www.c!c.gov8obesity8causes8health.html.

44 l Nursing2011 l November

7/17/2019 Document(1)


besity and asth!a"

Increasing together

A$&'!a i$ a "'roni" in(a!!a&or%

di$ea$e &'a& ae"&$ &'e airwa%$#,@

7o$& pa&ien&$ wi&' a$&'!a e6'i)i&

in"rea$ed wor= o )rea&'ing and

de"rea$ed p-(!onar% -n"&ion !ea3

$-re!en&$ $-"' a$ &ida( 1o(-!e 4T95,

ER9, ;E9*, and ;9C#+,*

Ri$ing a$&'!a ra&e$ and poor!anage!en& o &'e di$ea$e are

in"rea$ing(% (in=ed &o o)e$i&%#+,*

;e!a(e$ are !ore (i=e(% &o 'a1e

a$&'!a &'an !a(e$#**

A $!a(( per3"en&age o &'o$e wi&' a$&'!a !a%'a1e gained weig'& )e"a-$e oa$&'!a !edi"a&ion$ 4$-"' a$ ora("or&i"o$&eroid$5 and $eden&ar% (ie3

$&%(e$#+

O)e$i&% in"rea$e$ &'e wor= o

)rea&'ing and pro)a)(% e6a"er)a&e$a$&'!a $%!p&o!$ "a-$ed )% &'e

in(a!!a&or% pro"e$$ and $!oo&'

!-$"(e "on&ra"&ion in &'e airwa%#+

Brea&'ing a& (ow (-ng 1o(-!e$ "o-(d

(ead &o di!ini$'ed airwa% $&re&"' 4or

e(a$&i"i&%5# S!oo&' !-$3"(e (a%er$ o

&'e "ond-"&ing airwa%$ "on&ain

$&re&"' re"ep&or$ &'a& are ae"&ed )%

pre$$-re "'ange$ wi&'in &'e airwa%$#

T'e$e re"ep&or$, w'i"' i!pede

in$pira&ion and $&i!-(a&e e6pira&ion,

p(a% an e$$en&ia( ro(e in e$&a)(i$'ing

)rea&'ing pa&&ern$ and red-"ing

)rea&'ing eor&# T'e% do $o )%

!a=ing adF-$&!en&$ in &'e T9 and

re$pira&or% ra&e &o a((ow or "'ange$

in airwa% re$i$&an"e and (-ng

"o!p(ian"e# Red-"ed airwa% $&re&"'

!a% "rea&e airwa% '%per3

re$pon$i1ene$$, an a!p(iied )ron3

"'o"on$&ri"&or rea"&ion &o $&i!-(i

&'a& 'a1e !ini!a( &o no "on$e3

-en"e$ on o&'er$#*,*2

Infla!!atory effects

O)e$i&%, a pro3in(a!!a&or% "ondi3

&ion, in"rea$e$ &'e n-!)er o in(a!3!a&or% !edia&or$ and "%&o=ine$ $-"'

a$ (ep&in, &-!or ne"ro$i$ a"&or3a(a

4TN;3a(a5, in&er(e-=in3 4I35, and

C3rea"&i1e pro&ein 4CRP5# Airwa%

in(a!!a&ion "on&ri)-&ing &o &'e

progre$$ion o a$&'!a 4or airwa%

'%perre$pon$i1ene$$5 !a% )e pro3

!o&ed )% &'e$e !edia&or$ and "%&o3

=ine$, w'i"' are e!i&&ed )%

adipo"%&e$# Adipocytes are a& "e(($ in

adipo$e &i$$-e 4)od% a&5 &'a& 'a1e a

"e((-(ar 1o(-!e "on$i$&ing !o$&(% o

p-re &rig(%"eride$#. Upper )od%

41i$"era(, "en&ra(, or a)do!ina(5

o)e$i&% i$ &'e !ain "on&ri)-&ing a"&or

in &'e "'roni" in(a!!a&or% re$pon$e$een in peop(e w'o are o)e$e#

@ 4See

Comparing apples and pears#5 ep&ini$ a pro&ein re(ea$ed )% adi3

po"%&e$ &'a& $-ppre$$e$ &'e appe&i&e )%

$igna(ing &'e $en$a&ion o $a&ie&% and

rai$e$ energ% e6pendi&-re# I&$ a($o a

pro3in(a!!a&or% 'or!one &'a&$

grea&(% in"rea$ed in o)e$e peo3p(e wi&'

a$&'!a, w'i"' $&i!-(a&e$ &'e re(ea$e o

&'e in(a!!a&or% "%&o3=ine$ I3 and

TN;3a(a#@,+

I3, &'e "'ie !edia&or in

a"-&e p'a$e re$pon$e, (ead$ &o &'e

prod-"&ion o CRP, w'i"' in&en$iie$&'e in(a!!a3&or% re$pon$e# I3 and

TN;3a(a are a$$o"ia&ed wi&' in"rea$ed

IgE pro3d-"&ion, $-)epi&'e(ia( i)ro$i$,

and re!ode(ing o &'e airwa%$, &'e pri3

!ar% pa&'ogene$i$ o a$&'!a#@

In a re"en& $&-d% o &'e re(a&ion3

$'ip o in(a!!a&or% "%&o=ine$ o

a$&'!a and o)e$i&%, Cano, e& a(#,

o-nd a po$i&i1e "orre(a&ion )e&ween

)io"'e!i"a( !ar=er$ 4$-"' a$ er%&'3

ro"%&e $edi!en&a&ion ra&e >ESR?,

CRP, TN;3a(a, and I3 (e1e($5 and para!e&er$ o o)e$i&% $-"' a$ B7I,

wai$& "ir"-!eren"e, and wai$&3&o3

'ip ra&io#@

Manage!ent of asth!a

T'e pri!ar% goa( o a$&'!a &rea&3

!en& i$ &o $a&i$a"&ori(% "on&ro( &'e

di$ea$e &o a"'ie1e op&i!a( p-(!o3nar%

-n"&ion, !ini!a( da%&i!e $%!p&o!$

and -$e o re$"-e )ron3"'odi(a&or$,

nor!a( a"&i1i&ie$ o dai(% (i1ing,

a)$en"e o nig'&&i!e $%!p&o!$, and

on(% !i(d and inre3-en&e6a"er)a&ion$# 7o$& pa&ien&$ "an

a"'ie1e $a&i$a"&or% "on&ro( wi&'

indi1id-a(ied dr-g &'erap%, a$&'!a

ed-"a&ion, en1iron!en&a( "on&ro(

!ea$-re$, and appropria&e o((ow3-p#

A$&'!a !a% )e !ore dii"-(& &o

"on&ro( in pa&ien&$ w'o are o)e$e# T'i$

dii"-(&% !a% )e a$$o"ia&ed wi&' a"&or$

$-"' a$ o)e$i&%3ind-"ed airwa%

www.Nursing2011.com

Copyright © 2011

Lippincott Williams

& Wilkins. Unauthorized reproduction of this article is

prohibited.

#uide to res$iratory abbre%iations&bbre%iation 'er! (efinition

#) #6nea&hy6o6nea $otal number of a6neas an! hy6o6neas

in!e4 6er hour of slee

'# 'ontinuous 6ositive ositive 6ressur

airway 6ressure airway, which s6

an! 6revents O+

DL'O Diffusion in the lung art of a 6ulmon

7/17/2019 Document(1)


of carbon mono4i!e assess gas movement from the alveoli to

the erythrocytes in the 6ulmonary ca6il&

laries. 'arbon mono4i!e is use! to ma:e

this measurement because it mimics the

behavior of o4ygen.

%R; %46iratory reserve "a4imum volume of air that can be

volume e4hale! from the resting en!&e46iratory

level(%;1 (orce! e46ire! ;olume of air e46ire! in the first secon!

volume in 1 secon! of (;'

(R' (unctional resi!ual ;olume of air remaining in the lungs at

ca6acity en!&e46iration <R; = %R;>

(;' (orce! vital ca6acity "a4imum amount of air that can be ra6&

i!ly an! forcefully e4hale! from the lungs

after full ins6iration

RD Res6iratory $otal number of events <a6neas, hy6o&

!isturbance in!e4 6neas, an! res6iratory effort&relate!

arousals> 6er hour of slee69 also see #)

R; Resi!ual volume ;olume of air remaining in the lungs after

ma4imal e46iration, measure! in!irectly

$L' $otal lung ca6acity $otal amount of air that the lungs canhol! after ma4imal ins6iration

$; $i!al volume #mount of air that moves in an! out of

lungs with each breath

#!a6te! from orth '". Essentials of Pathophysiology . 3r! e!. hila!el6hia, #5 ?olters @luwer )ealth8Li66incott ?illiams A ?il:ins9 2011.

)id(% o)e$e pa&ien&$ w'o1e -nder3gone

)aria&ri" $-rger%#+ Baria&ri" $-rger% i$

&%pi"a((% re$er1ed or $e1ere(% o)e$e

peop(e w'o aren& a)(e &o (o$e weig'&#*.

T'e$e pa&ien&$, a$ a re$-(& o inee"&i1e

n-&rien& a)$orp3&ion and ear(% $a&ie&%

prod-"ed )% in&e$&ina( )%pa$$ and/or

ga$&ri" re$&ri"3&ion, re$pe"&i1e(%, (o$e a$ignii"an& a!o-n& o weig'& wi&'in &'e

ir$& *2 &o *@ !on&'$ a&er &'e

pro"ed-re#*

E1en !ode$& a!o-n&$ o

weig'& (o$$ are a$$o"ia&ed wi&'

i!pro1ed a$&'!a $e1eri&% and "on&ro(#+

To -r&'er !anage $%!p&o!$,

in$&r-"& a pa&ien& wi&' a$&'!a &o )eaware o e6er"i$e3ind-"ed a$&'!a a$ p'%$i"a( a"&i1i&% in"rea$e$ and &o

a1oid &rigger$ $-"' a$ po((en, d-$&,d-$& !i&e$, "a&$, -!e$, "'ange$ in

&e!pera&-re, and $!o=e#*

besity and C)("

*aising the ris+s

COPD, w'i"' in"(-de$ e!p'%$e!a and

"'roni" )ron"'i&i$, i$ a$$o"ia&ed wi&' an

a)nor!a( in(a!!a&or% re$pon$e o &'e

(-ng$ d-e &o no6io-$ $&i!-(i# T'e$e

di$ea$e$ 'a1e !an% "o!!on $ign$ and

$%!p&o!$, $-"' a$ $'or&ne$$ o )rea&',

"o-g', e6er"i$e in&o(eran"e, and air(ow

(i!i&a&ion &'a&$ no& "o!p(e&e(%

re1er$i)(e#*

T'e pop-(a&ion o pa&ien&$ wi&' COPD

i$ growing a$ a$& a$ &'e pop-(a3&ion o&'o$e wi&' o)e$i&%#

Bo&' "ondi3&ion$ are

!aFor "a-$e$ o !or&a(i&% and

"'ange$ 4or in$&an"e, in"rea$ed airwa%

in(a!!a&ion and $!oo&' !-$"(e

"on&ra"&ion5, di!ini$'ed re$pon$i1e3ne$$

&o $o!e !edi"a&ion$ 4$-"' a$ in'a(ed

"or&i"o$&eroid$ and (ong3a"&ing $&eroid$5,

or &'e i!pa"& o o)e$i&%3re(a&ed

"o!or)id "ondi&ion$ 4$-"' a$

o)$&r-"&i1e $(eep apnea and ga$&ro3

e$op'agea( re(-6 di$ea$e >GERD?5#+

O&'er a$$o"ia&ed a"&or$ !a% in"(-de &'e

'or!ona( ee"&$ o in"rea$ed e$&rogenin e!a(e$ w'o are o)e$e 4i& !a%

in&erere wi&' &'e i!!-ne re$pon$e5 and

wor$ening o a$&'!a $%!p&o!$ in o)e$e

peop(e wi&' a$&'!a &'a&$ (in=ed &o

&'eop'%((ine -$e 4w'i"' !a% "on&ri)-&e

&o GERD )% de"rea$ing (ower

e$op'agea( $p'in"&er &one5#,*

Tai(ored

p'ar!a3

www.Nursing2011.com

"o&'erap% i$ an

i!por&an&

!anage3!en&

"on$idera&ion in

&'e$e pa&ien&$#

O)e$i&%,

$!o=ing, and

p'%$i"a(

ina"&i1i&% are

!odiia)(e ri$=

a"3&or$ &'a& "an

"a-$e or e6a"er)a&e

a$&'!a#**

S!o=ing i$ a($o

a$$o"ia&ed wi&' a

de"rea$ed

re$pon$e &o "or&i3

"o$&eroid$#**

T'e =e% &oweig'& (o$$ i$ &o )a(3an"e energ%in&a=e wi&'energ%

e6pendi&-re#+

E6er"i$e &rainingi$ an ee"&i1e and$ae wa% or &'o$ewi&' a$&'!a &oi!pro1e i&ne$$and e6er3"i$e peror!an"e#a(=ing 4o((ow3ing U#S# p'%$i"a(a"&i1i&%

g-ide(ine$5 i$appropria&e e1enor &'o$e wi&'

$e1ere a$&'!a#*8

T'e !o$&dra!a&i"i!pro1e!en&$ ina$&'!a$%!p&o!$ o""-rin !or3

!or)idi&%#

A)do!ina( o)e$i&%

i$ a)o-& &wi"e a$

pre1a(en& in

pa&ien&$ diagno$ed

wi&' COPD#. T'e

(ong3&er! ee"&$

o o)e$i&%, $-"' a$

(ow3grade

$%$&e!i"

in(a!!a&ion and

in$-(in re$i$&an"e,

"o-(d a($o

"on&ri)-&e &o

in"rea$ed

"ardio1a$"-(ar

di$ea$e and

!or&a(i&%#.

7o$& pa&ien&$wi&' COPDe6'i)i& anonre1er$i)(ede"rea$e in

;E9* and ;9C

4)o&' 1a(-e$ are(e$$ &'an @0 o predi"&ed 1a(-e$5a(ong wi&' an

;E9*/;9C ra&ioo (e$$ &'an 0#Un(i=e pa&ien&$wi&' a$&'!a w'o'a1e i!pro1ed(-ng -n"&ionwi&' &rea&!en&,

air(ow (i!i&a&ion per$i$&$ in pa&ien&$ wi&'

COPD# T'e

wor= o )rea&'ing ando6%gen de!andi$ in"rea$edw'e&'er &'e$e pa&ien&$ are a&re$& or e6er"i$ing#

November lNursing2011 l 4,

Copyright ©

2011

Lippincott

Williams &

Wilkins.

Unauthorize

d reproduction of this article is

prohibited.

i&' e6er"i$e and in"rea$ed 1en&i3 (a&or% re-ire!en&$, &'e$e pa&ien&$ !a%

7/17/2019 Document(1)


'a1e e6pira&or% (ow (i!i&a&ion$ &'a&

"an (ead &o "on$idera)(e air &rap3ping

and an in"rea$ed end3e6pira&or% (-ng

1o(-!e, a$ re(e"&ed in &'e ;RC

!ea$-re!en&# Re$&ri"&i1e dei"i&$

"o!)ined wi&' air(ow (i!i&a&ion re$-(&

in in"rea$ed $'or&ne$$ o )rea&' and

e6er"i$e (i!i&a&ion$# In &'e ear(% $&age$o COPD, 1i$"era( o)e$i&% 'a$ an

e$pe"ia((% nega&i1e i!pa"& on e6er"i$e

peror!an"e#

Sere$, e& a(# 4a$ repor&ed )% Ra!a"'3

andran, e& a(#5 o-nd &'a& di!ini$'ed

e6er"i$e a)i(i&% in pa&ien&$ w'o were

!or)id(% o)e$e wa$ (in=ed &o in"rea$e$ in

o6%gen re-ire!en&$, $%$&o(i" BP, and

'ear& ra&e# T'e re$ear"'er$ &'eo3ried &'a&

&'e$e pa&ien&$ wi&' (arger )od% !a$$e$

re-ired addi&iona( energ% &o "rea&e

!o&ion d-e &o &'eir di!ini$'ed e6er"i$e

a)i(i&%#

Manage!ent of C)(

eig'& (o$$ i$ &'e )e$& 'ea(&' $&ra&eg% or

o)e$e pa&ien&$ wi&' COPD# Cardia" ri$=

a"&or$ $-"' a$ '%per&en$ion, dia3)e&e$,

d%$(ipide!ia, and o)e$i&%

$'o-(d )e e1a(-a&ed and !anaged

a""ording &o "-rren& e1iden"e3)a$ed

g-ide(ine$# Adding p-(!onar% re'a3

)i(i&a&ion and e6er"i$e &raining !a%

in"rea$e &'e ee"&i1ene$$ o weig'&3(o$$

p(an$ and red-"e "ardia" ri$= a"&or$#

Co!!on &'erape-&i" re"o!!en3da&ion$ in"(-de -$ing )ron"'odi(a3&or$, $-pp(e!en&a( o6%gen, in'a(edor $%$&e!i" "or&i"o$&eroid$, an&i)io&3i"$, and !e&'%(6an&'ine$ 4&'eop'%(3

(ine5 a$ indi"a&ed#*@

1• S'or&3a"&ing )ron"'odi(a&or$

$-"' a$ a()-&ero( and $'or&3 or (ong3

a"&ing an&i"'o(inergi"$ $-"' a$

ipra&ropi-! or &io&ropi-! are

pre$"ri)ed &o re(a6 $!oo&' !-$"(e$

and i!pro1e $%!p3&o!$#

2• O6%gen $'o-(d )e "on$idered

or o)e$e pa&ien&$ wi&' '%po6i" COPD,

a$ we(( a$ &'o$e wi&' &%pe 2 dia)e&e$ and

in$-(in re$i$&an"e, )e"a-$e $-pp(e3!en&a(

o6%gen in"rea$e$ in$-(in $en$i&i1i&% and

g(-"o$e &o(eran"e#. A""ording &o &'e

G(o)a( Ini&ia&i1e or C'roni" O)$&r-"&i1e

-ng Di$ea$e 4GOD5 g-ide(ine$,

o6%gen &'erap% $'o-(d )e ini&ia&ed or

pa&ien&$ wi&' $&age I9 COPD# Pa&ien&$

"a&egoried

a$ $&age I9 'a1e 1er% $e1ere COPD

4;E9*/;9C (e$$ &'an # and ;E9*

(e$$ &'an 80 o predi"&ed 1a(-e$, or

;E9* (e$$ &'an 0 o predi"&ed 1a(3

-e$ wi&' "'roni" re$pira&or% ai(-re5#

T'e GOD g-ide(ine$ gi1e &'e goa( or

o6%gen &'erap% 4re$&ing PaO2 o a& (ea$&

!! Hg and/or SaO2 grea&er &'an+0 a& $ea (e1e(5# A""ording &o &'eGOD g-ide(ine$, &'e indi"a&ion$ oro6%gen &'erap% a(( in&o &wo "a&ego3

rie$: ir$&, or &'o$e w'o 'a1e a PaO2 o

!! Hg or (e$$ or SaO2 o @@0 or(e$$ wi&' or wi&'o-& '%per"apnia 4a

PaCO2 grea&er &'an . !! Hg5 $e"3

ond, or &'o$e w'o 'a1e a PaO2 &o

!! Hg or SaO2 o @@0 and $'owe1iden"e o p-(!onar% '%per&en$ion, p-(!onar% ede!a 4w'i"' $-gge$&$'ear& ai(-re5, or a 'e!a&o"ri& grea&er

&'an 0#*@

In'a(ed "or&i"o$&eroid$ $'o-(d )e

gi1en or pa&ien&$ wi&' $&age III or I9

COPD 4$e1ere or 1er% $e1ere5 i

&'e%re 'a1ing repea&ed e6a"er)a&ion$

in order &o red-"e &'e re-en"% o

e6a"er)a&ion$ and red-"e airwa%

in(a!!a&ion# 4S%$&e!i" "or&i"o$&e3

roid$ are re"o!!ended on(% or

$'or&3&er! &rea&!en& o e6a"er)a3&ion$ )-& no& on a (ong3&er! )a$i$#5

*@

Co!$aringa$$les and$ears

Distribution of

a!i6ose tissue in

u66er bo!y or

central <visceral>

obesity an! lower

bo!y or 6eri6heral

<subcutaneous>

obesity. eo6le

with u66er bo!y

obe&sity are often

consi!ere! a66le&

sha6e!, while

those with lower

bo!y obesity are

consi!ere! 6ear&sha6e!.

+ource5 orth '".Essentials ofPathophysiology . 3r!e!. hila!el6hia, #5?olters @luwer)ealth8Li66incott?illiams A ?il:ins92011.

4- l Nursing2011l November

An&i)io&i"$ are -$e-( or pa&ien&$

wi&' COPD w'o are e6perien"ing

ine"&io-$ e6a"er)a&ion$ and/oro&'er

)a"&eria( ine"&ion$, )-& &'e%

$'o-(dn&

)e -$ed a$ prop'%(a"&i" &'erap%#*@

7e&'%(6an&'ine$ 4$-"' a$ &'eo3

p'%((ine5 'a1e )een $'own &o )e

ee"&i1e in COPD a$ )ron"'odi(a3

&or$, )-& d-e &o &'eir ad1er$e rea"3

&ion$ and po&en&ia( &o6i"i&%,

in'a(ed )ron"'odi(a&or$ are pre3

erred &o &rea& )ron"'o$pa$!#*@

Be$ide$ 'e(ping &o e$&a)(i$' &'eCOPD diagno$i$, p-(!onar% -n"3

&ion &e$&$ "an 'e(p a$$e$$ &'e pa&ien&$

re$pon$e &o &rea&!en&# A pa&ien&wi&'

1en&i(a&or% ai(-re !a% need"on&in-3

o-$ po$i&i1eairwa% pre$$-re4CPAP5

or endo&ra"'ea(in&-)a&ion#

besity and

obstructi%e

slee$ a$nea"

Co!!on

bedfellowsSleep apnea i$

deined a$ &'e

"e$$a&ion o

air(ow or a& (ea$&

* $e"ond$ "or3

re$ponding wi&'

an aro-$a( ro!

$(eep

www.Nursing2011.com

Copyright ©

2011

Lippincott Williams &

Wilkins. Unauthorized

reproductio

n of this

article is prohibited.

or o6%'e!og(o)in de$a&-ra&ion#*.

Obstructive sleep apnea 4OSA5 i$ "'ar3

a"&eried )% "on&in-ing re$pira&or% eor&

in &'e a"e o an a)$en"e or $eri3o-$

i!pair!en& o air(ow# OSA i$ "a-$ed )%

re"-rring epi$ode$ o -pper airwa%

o)$&r-"&ion, -$-a((% )% &'e &ong-e and

p'ar%ngea( &i$$-e$# D-r3ing $(eep, &'e

!-$"(e$ o &'e -pper airwa% re(a6 and &'e

airwa% opening &end$ &o "o((ap$e# A$ &'e

diap'rag! "on&ra"&$ and !o1e$

downward &o genera&e nega&i1e pre$$-re

in &'e (ower airwa%$ &o in$pire air, &'e

-pper airwa% "o((ap$e$ a$ &'e &i$$-e$ and&'e &ong-e are $-"=ed in&o &'e airwa%

opening# A& a !ini!-!, &'i$ "a-$e$

$noring, )-& i& !a% a($o "a-$e de"rea$ed

!o1e!en& o air 4'%popnea5 and/ or

airwa% o)$&r-"&ion re$-(&ing in apnea#*+

T'e pa&ien& i$ a$(eep, -naware o &'i$

$erie$ o e1en&$ re(a&ed &o )rea&'ing, and

re$pira&or% eor&$ "on&in-e, a(&'o-g'

air(ow i$ dra!a&i3"a((% red-"ed or"o!p(e&e(% $&opped# H%po6e!ia and

'%per"apnia de1e(op, and e1en&-a((% &'e

pa&ien&$ $(eep !o1e$ ro! a (ower (e1e(

7/17/2019 Document(1)


or $&age &o a 'ig'er (e1e( 4aro-$a(5# i&'

&'i$ "'ange in )rain a"&i1i&% 4a$ !ea$-red

)% e(e"&roen"ep'a(ograp'%5, )rea&'3ing

re$-!e$# T'e '%po6e!ia and '%per"apnia

re1er$e a$ air(ow re$&ar&$, )-& $oon &'e

"%"(e )egin$ again# T'i$ pa&&ern re"-r$

&'ro-g'o-& &'e $(eep &i!e# S(eep i$

di$r-p&ed )% &'e$e re-en& aro-$a($#2

Ana&o!i" a(&era&ion$ in peop(e w'o

are o)e$e in"rea$e &'e ri$= o airwa%

"o((ap$e d-ring $(eep#*,2*

Ri$= a"&or$

or OSA in"(-de o)e$i&%, a)nor!a(i&ie$

in &'e -pper airwa% and a"ia(

$&r-"&-re$, and pro)(e!$ re(a&ed &o &'e

$o& &i$$-e$ in &'e -pper airwa% 4$-"'

a$ en(arged &on3$i($, &ong-e, or -1-(a5#

Po&en&ia( ri$= a"&or$ or OSA in"(-de

'eredi&%, $!o=ing, na$a( "onge$&ion,

and dia3)e&e$# Signii"an& OSA e6i$&$in a)o-& .0 o peop(e w'o are o)e$e,

and a)o-& 0 o &'o$e wi&' OSA are

o)e$e# In"rea$ed )od% weig'& i$

a$$o"ia&ed wi&' in"rea$ed "o((ap$i)i(3

i&% o airwa%$ in OSA#2

T'e &o&a( n-!)er o apnea$ and'%popnea$ per 'o-r o $(eep i$ gen3

www.Nursing2011.com

era((% repor&ed a$ &'e apnea3

'%popnea inde6 4AHI5, w'i"' i$ &'e

!aFor inde6 o $(eep apnea $e1eri&%,

or &'e re$pi3ra&or% di$&-r)an"e inde6

4RDI5# OSA i$ deined a$:

1• 7ore &'an * apnea$,

'%popnea$, or re$pira&or% eor&J

re(a&ed aro-$a($ 4RERA$5 per 'o-r o

$(eep 4&'a& i$, an AHI or RDI grea&er

&'an * e1en&$ per 'o-r5 in an

a$%!p&o!a&i" pa&ien&, OR

2• 7ore &'an i1e apnea$,

'%popnea$, or RERA$ per 'o-r o

$(eep 4&'a& i$, an AHI or RDI grea&er

&'an e1en&$ per 'o-r5 in a pa&ien&

wi&' $%!p&o!$ 4$-"' a$ $(eepine$$,

a&ig-e, and ina&&en&ion5 or $ign$ o

di$&-r)ed $(eep 4$-"' a$ $noring,

re$&(e$$ $(eep, and re$pira&or% pa-$e$5#

7ore &'an 0 o &'e apnea$ or

'%popnea$ !-$& 'a1e an o)$&r-"&i1e

pa&&ern#

T'e "on$e-en"e$ o OSA in"(-de a

'o$& o pro)(e!$# ;re-en& in&er3

r-p&ion$ in -a(i&% $(eep &i!e (ead &o

e6"e$$i1e da%&i!e $(eepine$$ and (o$$

o "ogni&i1e -n"&ion# T'e$e pa&ien&$

a"e an in"rea$ed ri$= o $e1ere ar&e3

ria( '%po6e!ia, 'ig'er $%!pa&'e&i"

&one, $%$&e!i" and p-(!onar% '%per3

&en$ion, "ardia" d%$r'%&'!ia$, 'ear&

ai(-re, "'roni" $noring, "ardio1a$"-3

(ar di$ea$e, and $&ro=e$#*.,2*

Se1ere OSA 4deined a$ an AHIgrea&er &'an 85 "arrie$ a &'ree3 &o

$i6o(d in"rea$ed ri$= in a((3"a-$e

!or&a(i&% "o!pared &o nor!a( peop(e#

Pa&ien&$ wi&' OSA a($o 'a1e !ore

!o&or 1e'i"(e "ra$'e$, w'i"' are

"a-$ed w'en &'e% a(( a$(eep w'i(e

dri1ing# T'e%re a($o a& 'ig'er ri$= or

periopera&i1e pro)(e!$, $-"' a$

dii"-(& endo&ra"'ea( in&-)a&ion and

(onger ane$&'e$ia re"o1er% &i!e#

A(&'o-g' o)e$i&% a!p(iie$ &'eri$= o OSA, OSA "an a($o pro!o&e

weig'& gain and o)e$i&%# S&-die$ 'a1e$'own &'a& !an% pa&ien&$ new(%diag3no$ed wi&' OSA 'a1e re"en&(%gained e6"e$$i1e weig'&#

Manage!ent of &

T'e goa( o &rea&!en& in OSA i$ &o

de"rea$e &'e $e1eri&% o re$pira&or%

e1en&$ a$$o"ia&ed wi&' $(eep aro-$a(

and o6%'e!og(o)in de$a&-ra&ion#2,2*

CPAP, &'e &rea&!en& o "'oi"e or o)e$e

pa&ien&$ wi&' OSA, !a% (ower

BP and i!pro1e endo&'e(ia( -n"3

&ion#,2

;or a pa&ien& wi&' OSA w'oneed$ a CPAP !a$=, en$-re &'a& i&i&$ proper(%#

E1iden"e $-ppor&$ !edi"a( and

$-rgi"a( &rea&!en& or weig'& (o$$ &o

i!pro1e OSA# I weig'& (o$$ eor&$

ai(, )aria&ri" $-rger% $'o-(d )e "on$id3ered#

,*,2* Baria&ri" $-rger% 'a$ )een

$'own &o red-"e pa&ien&$ B7I )%

aro-nd * =g/!2 and red-"e &'eir AHI

)% 8 e1en&$ per 'o-r# T'i$ $-g3ge$&$

&'a& e1er% red-"&ion in B7I o * -ni& i$

(in=ed &o a red-"&ion in &'e AHI o 2#8

-ni&$#22

Nursing considerations

Here are $o!e o &'e !o$& i!por&an&

"on$idera&ion$ w'en "aring or ano)e$e pa&ien& wi&' a$&'!a, COPD, or

OSA:1• Ed-"a&e &'e pa&ien& a)o-&

o)e$i&% and i&$ ad1er$e ee"&$#2*

2• eig' &'e pa&ien& and

"a("-(a&e B7I and, -$ing "(ini"a(

g-ide(ine$, a$$i$& in de1i$ing a p(an

&o 'e(p &'e pa&ien& a&&ain a de$ired

weig'&#**

3• A$$e$$ or weig'&"'ange$ d-ring o((ow3-p 1i$i&$#

4• En"o-rage 'ea(&'% ea&ing

'a)i&$ and in"rea$ed p'%$i"a(

a"&i1i&% &o $-ppor& weig'&3(o$$

eor&$#+

5• Ed-"a&e &'e pa&ien& a)o-& &'edan3ger$ o $!o=ing and pro1ide$!o=3ing "e$$a&ion re$o-r"e$ i

indi"a&ed#**

6• Tea"' &'e pa&ien& a)o-& pre$"ri)ed !edi"a&ion$, in"(-ding proper -$e o in'a(er$#

7• Ed-"a&e &'e pa&ien& a)o-& &'e

$ae -$e o $-pp(e!en&a( o6%gen, i

pre$"ri)ed#.

8• 7oni&or ar&eria( )(ood ga$re$-(&$, o6%gen $a&-ra&ion (e1e($,

$er-! e(e"&ro(%&e (e1e($, and (-id$&a&-$ a$ pre$"ri)ed#

28

9• En"o-rage &'e pa&ien& &o

$ee= !edi"a( a&&en&ion a& &'e on$e&

o new $ign$ and $%!p&o!$,

)eore re$pira&or% di$&re$$ o""-r$#

10• Te(( &'e pa&ien& a)o-&

addi&iona( inor!a&ion a1ai(a)(e

ro! &'e A!eri"an -ng

A$$o"ia&ion and o&'er re$o-r"e$#8,*

O)e$i&% 'a$ a (arge nega&i1e ee"&

on &'e p-(!onar% $%$&e!, par&i"-3(ar(%

in pa&ien&$ wi&' &'e "o!or)id

"ondi&ion$ o a$&'!a, COPD, and

November l Nursing2011 l 4/

7/17/2019 Document(1)


Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

OSA# U$ing a !-(&idi$"ip(inar% &ea!

approa"' &'a& in1o(1e$ &'e pri3!ar%

"are pro1ider, n-r$e, re$pira3&or%

&'erapi$&, o""-pa&iona(/p'%$i"a(

&'erapi$&, and n-&ri&ioni$& "an pro3

1ide a $o(id o-nda&ion or i!pro13ing pa&ien&$ (i1e$# He(ping pa&ien&$

a"'ie1e a 'ea(&'ier (ie$&%(e )% (o$ing

weig'& and -i&&ing $!o=ing are

i!por&an& $&ep$ &oward i!pro1ed

re$pira&or% -n"&ion# 'en appro3

pria&e, &'e "orre"& !edi"a&ion$, CPAP,

and )aria&ri" $-rger% "an red-"e

re$pira&or% $%!p&o!$ and i!pro1e

-a(i&% o (ie#

RE;ERENCES

1. Tr-$& or A!eri"a$ Hea(&'# ; a$ in

;a&: 'ow o)e$i&% &'rea&en$ A!eri"a$ -&-re#2*# '&&p://'ea(&'%a!eri"an$#org/repor&$/o)e$i&%2*/#

2. Cen&er$ or Di$ea$e Con&ro( and

Pre1en&ion# O)e$i&% and o1erweig'& or proe$$iona($: 'ea(&' "on$e-en"e$# 2**#'&&p://www#"d"#go1/o)e$i&%/ "a-$e$/'ea(&'#'&!(#

3. Cen&er$ or Di$ea$e Con&ro( and

Pre1en&ion# O)e$i&% and o1erweig'& or proe$$iona($: deining o1erweig'& and o)e$i&%# 2*#'&&p://www#"d"#go1/ o)e$i&%/deining#'&!(#

4. ;ran$$en ;7, ODonne(( DE, Goo$$en$

GH, B(aa= EE, S"'o($ A7# O)e$i&% and &'e (-ng: #

O)e$i&% and COPD# Tora!" 2@84*25:***3***#

5. Ra!a"'andran K, 7"C-$=er C,

Conner$ 7, L-wa((a"= R, a'iri B# T'e in (-en"e o o)e$i&% on p-(!onar% re'a)i(i&a&ion o-&"o!e$ in

pa&ien&$ wi&' COPD# Cron Respir #is#[email protected]:232+#

6. Enrig'& P# Reeren"e 1a(-e$ or

p-(!onar% -n"&ion &e$&ing# 2*#'&&p://www#-p&oda&e#"o!/ "on&en&$/reeren"e31a(-e$3or3p-(!onar%3-n"&ion3&e$&ing#

7. Po-(ain 7, Do-"e& 7, 7aFor GC, e& a(#

T'e ee"& o o)e$i&% on "'roni" re$pira&or% di$ea$e$: pa&'o3p'%$io(og% and &'erape-&i" $&ra&egie$# CMA$ #2*.4+5:*2+83*2++#

8. Cano 7, Erdenen ;, U-n H,

7Mderri$og(- C, A%din S# T'e re(a&ion$'ip oin(a!!a&or% "%&o3=ine$ wi&' a$&'!a and o)e$i&%#Clin Invest Med # 2@8*45:E883E8+#

9. Bo-(e& P# In(-en"e o o)e$i&% on &'e

pre1a(en"e and "(ini"a( ea&-re$ o a$&'!a# Clin Invest Med" 2@8*45:E8@3E8+#

10. Di6on AE, S'ade D7, Co'en RI, e& a (#

Ee"& o o)e$i&% on "(ini"a( pre$en&a&ion andre$pon$e &o &rea&!en& in a$&'!a# $ Astma#2.845:83@#

11. S&rine T, Ba((- S, ;ord ES# T'e

a$$o"ia&ion$ )e&ween $!o=ing, p'%$i"a( ina"& i1i&%,o)e$i&%, and a$&'!a $e1eri&% in &'e genera( US

pop-(a&ion# $ Astma# 2..4@5:*3@#

12. Por&' C7# %ssentials of

&atopysiology# 8rd ed# P'i(ade(p'ia, PA: o(&er$K(-wer Hea(&'/ippin3"o&& i((ia!$ i(=in$2**#

13. U#S# Depar&!en& o Hea(&' and H-!an

Ser31i"e$# P'%$i"a( A"&i1i&% G-ide(ine$ or A!eri"an$#

2@# '&&p://www#'ea(&'#go1/pag-ide(ine$/#

14. Na&iona( Hear&, -ng, B(ood

In$&i&-&e# G-ide(ine$ on o1erweig'& and o)e$i&%:e(e"&roni" &e6&)oo=# Appendi6 I9# O)e$i&% and$(eep apnea#'&&p://www#n'()i#ni'#go1/g-ide(ine$/o)e$i&%/e&6&)=/appnd6/apnd6.#'&!#

15. S"'war& AR, Pa&i( SP, aan A7,

Po(o&$=% 9, S"'neider H, S!i&' P# O)e$i&% ando)$&r-"&i1e $(eep apnea: pa&'ogeni" !e"'ani$!$and &'era3pe-&i" approa"'e$# &roc Am Torac Soc#2@425: *@3*+2#

16. Na&iona( A$&'!a Ed-"a&ion and

Pre1en&ion Progra!# E6per& Pane( Repor&# 8:g-ide(ine$ or &'e diagno$i$ and !anage!en& oa$&'!a# 2#

'&&p://www#n'()i#ni'#go1/g-ide(ine$/a$&'!a/a$&'gd(n#pd#

17. A!eri"an -ng A$$o"ia&ion# C'roni"

o)$&r-"3&i1e p-(!onar% di$ea$e 4COPD5# ;a"& $'ee&#2**# '&&p://www#(-ng-$a#org/(-ng3di$ea$e/"opd/re$o-r"e$/a"&$3ig-re$/COPD3;a"&3S'ee&#'&!(#

18. T'e G(o)a( Ini&ia&i1e or C'roni"

O)$&r-"&i1e -ng Di$ea$e 4GOD5# ;ro! &'e G(o)a(S&ra&eg% or &'e Diagno$i$, 7anage!en& andPre1en&ion o COPD#'&&p://www#go(d"opd#org/-p(oad$/-$er$/i(e$/GODRepor&Apri(**2**#pd#

19. Randera&' , ;ie&e I# He w'o "o!e$

&oo (a&e i$ p-ni$'ed )% (ieQa paradig! $'i& in p-(!o3nar% $(eep !edi"ine: in&rod-"&ion# Respiration# 2+@4*5:*3.#

20. De!p$e% A, 9ea$e% SC, 7organ B,

ODonne( CP# Pa&'op'%$io(og% o $(eep apnea# &ysiol Rev# 2*+4*5:.3**2#

21. See C, 7en$a' E, O(opade CO#

O)e$i&%, e&'3ni"i&%, and $(eep3di$ordered )rea&'ing:!edi"a( and 'ea(&' po(i"% i!p(i"a&ion$# Clin Cest

Med # 22485:2*388#

22.Ro!ero3Corra( A, Cap(e$ S7, ope3i!ene ;, So!er$ 9K# In&era"&ion$ )e&ween o)e$i&%

and o)$&r-"&i1e $(eep apnea: i!p(i"a&ion$ or&rea&!en&# Cest" 2**8485:**3*+#

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p-(!o3nar% di$ea$e and e!p'%$e!a# e7edi"ineSpe"ia(3&ie$# E!ergen"% !edi"ine# P-(!onar%#2@#'&&p://e!edi"ine#!ed$"ape#"o!/ar&i"(e/@*.8#

Robin Lawson is a clinical associate 6rofessor in thea!ult health nursing !e6artment at the *niversity of+outh #labama in "obile, #la. Bill ruitt is also on thefaculty at the *niversity of +outh #labama where heserves as a senior instructor an! !irector of clinicale!ucation in car!iores6iratory sciences in the .'. 'ovey'ollege of #llie! )ealth.

$he authors an! 6lanners have ! isclose! that they haveno financial relationshi6s relating to this article.

DO&10.10C801.N*R+%.0000010.-03.-

7/17/2019 Document(1)


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