Home Care Chronic Disease

Prevention Program

Melanie S. Bunn RN,MS

A collaboration of Duke University, Division of Community Health and

University of South Carolina, School of Medicine

Homework review

• What did you do?

• What happened as you did that?

• Why do you think that happened?

• Here’s what might have happened.

• How does this impact the next time you try this?

Chronic Disease Prevention Program

• Module 1:Health/Illness, Vital Signs, Exercise, Nutrition

• Module 2: Motivational Interviewing• Module 3: End of Life• Module 4: Heart Attack• Module 5: COPD • Module 6: Stroke• Module 7: Hypertension• Module 8: Diabetes• Module 9: Congestive Heart Failure

Chronic Obstructive Pulmonary Disease (COPD)

Objectives

• Discuss how the lungs work and the impact of COPD on respiratory function

• Describe healthy lifestyle choices for the person who has COPD

• Demonstrate use of motivational interviewing with the person who has COPD

Other names for COPD

• Emphysema• Chronic bronchitis

Lung function

• Normal lungs are like a sponge• The holes in the sponge are where the

lungs are able to exchange carbon dioxide that the body produces, for oxygen

• Air (oxygen) travels down the windpipe (trachea) through the bronchi (breathing tubes) to the bronchioles (smaller tubes) to the alveoli (sacs) where oxygen and carbon dioxide are exchanged

Lung function (continued)

• The body needs oxygen to function• The airways and air sacs are normally

elastic and springy • The tubes are normally open and able to

clear dirt/debris that enters the lungs

Anatomy of the lungs

• Photo of lungs

What is COPD?

• Lung disease in which the lungs are damaged

• Typically occurs in smokers, but may happen with other environmental exposures and hereditary conditions

What is COPD?

• Breathing tubes that carry air in and out of the lungs are obstructed

• In COPD air sacs lose their elasticity and so they collapse or don’t inflate properly

• In COPD the breathing tubes are blocked with mucous and become swollen so air cannot move in and out

COPD facts

• 14 million people in the United States have COPD

• Develops slowly• Not contagious• Fourth leading cause of death in the

United States• There is no cure

Causes

• Exposure to pipe, cigar, tobacco smoke• Exposure to second hand smoke• Exposure to heavy air pollution• Exposure to heavy dust• Exposure to chemical/toxic fumes• Genetic conditions

Signs and symptoms

• Wheezing• Coughing• Sputum production• Shortness of breath • Chest tightness

Diagnosis

• Clinical symptoms• Chest x-ray• Lung function tests

Classification• At risk- breathing test normal, mild

symptoms• Mild- breathing test shows mild limitation,

increasing symptoms• Moderate- person will typically seek care

for symptoms, shortness of breath with significant exertion, lung tests abnormal

• Severe- shortness of breath with limited activity, lung tests abnormal

Treatment

• Eliminate exposure to things that cause COPD

• Quit smoking• Exercise and pulmonary rehabilitation• Inhaled medications to open the breathing

tubes or decrease the inflammation• Oxygen• Pneumococcal and flu vaccines

Medications

• Inhaler use• Spacer use• Discuss use

Meter dose inhaler

• Abbreviated MDI

• Aerosolized medicine in canister in plastic holder

Spacer

• Plastic tube that attaches to the inhaler

• Makes the use of the MDI easier

• Ensures delivery of the medication to the lungs

Meter dose inhaler/spacer use

• Remove the cap from the inhaler and from the spacer

• Shake the inhaler well• Attach the inhaler to the spacer• Exhale deeply• Purse lips around the mouthpiece• Take a slow breath in• Hold breath for at least ten seconds

Meter dose inhaler/spacer use

• Wait two to three minutes• Repeat process• Rinse mouth after use if using a steroid

inhaler

Warning symptoms

• Increasing shortness of breath• Increasing coughing and wheezing• History of fever

Warning signs*

• Increased wheezing• Decreased pulse ox • Fever ( greater than 101 degrees

Fahrenheit)• Increased pulse (greater than 100)• Decreased pulse (less than 60)• Increased respiratory rate

*ALL vital parameters are determined by RN supervisor and are patient specific

Other warnings

• Not taking medications