STRAIGHT NURSING CHRONIC OBSTRUCTIVE PULMONARY DISEASE WHAT IS COPD? COPD is a respiratory condition that involves progressive limitations in airflow. Some resources include asthma, bronchitis (chronic) and emphysema under the umbrella of COPD, but since asthma is essentially reversible it is now more common for it to be considered seperate from COPD. However, some resources will include all three under the umbrella of chronic obstructive pulmonary disease. CHRONIC BRONCHITIS inflammation chronic cough excessive mucus EMPHYSEMA alveolar destruction bronchiol collapse enlargement of airways less surface area for gas exchange COPD PATHOPHYSIOLOGY In both chronic bronchitis and emphysema, exposure to irritants causes chronic inflammation and tissue damage. In chronic bronchitis, this inflammation causes an increase in the size and number of mucus glands and goblet cells, the smooth muscle of the airway hypertrophies and you end up with a narrower airway. Ciliary function is also impaired. As you recall, the cilia move mucus and irritants out of the lungs. When the cilia cannot perform this function, this thick mucus tends to accumulate and is difficult for the patient to remove. This sets the patient up to be at high risk for respiratory infection. Patients with chronic bronchitis are also prone to bronchospasm, which further makes it difficult for the patient to get adequate airflow. This thick mucus and the thick airway wall lead to airway obstruction, especially during exhalation when airways are constricted. Ultimately this leads to hypoxemia. In emphysema, the alveoli and bronchial tissues are damaged leading to less available surface area for gas exchange, airway collapse, and hypoxemia. Patients with COPD will have difficulty with the expiratory phase of respiration for three reasons: airway obstruction, loss of elastic recoil, and airway collapse. These patients can typically breathe in just fine (at least initially) but aren't able to fully exhale. This leads to air trapping, which then leads to hyperexpansion, hypoventilation, hypoxemia and hypercapnia.
STRAIGHT NURSING WHO IS AT RISK FOR COPD? Modifiable risk factors: · Smoking (most significant factor) · Poor air quality (occupational or general air pollution) Other risk factors: · Alpha-1 antitrypsin deficiency: This is an inherited disorder where the individual lacks an enzyme that is protective to the lungs. · Inadequate fetal lung development: mother smoking, pre-term birth, exposure to poor air quality, prenatal antibiotics. · Low birthweight · Childhood asthma · Frequent childhood respiratory infections · Childhood obesity THE LATTE METHOD HOW WILL THE PATIENT LOOK? · Shortness of breath, low pulse oximetry SpO2. · Productive cough (more mucus with chronic bronchitis than emphysema). Patient may state it is worse in the morning. · Wheezing, crackles, hyperresonance due to "trapped air" (more common with emphysema) · Tripod position · Pursed lip breathing: improves ventilation, releases trapped air, keeps the airways open longer for greater gas exchange, and can be calming for the patient. · Increased AP diameter with emphysema.due to chronic hyperinflation (AKA "barrel chest.") · Thin extremities due to muscle wasting secondary to large calorie expenditure · Enlarged neck muscles from increased WOB · Clubbing