Understanding Chronic Obstructive Pulmonary Disease

Sep 11, 2024

Lecture on Chronic Obstructive Pulmonary Disease (COPD)

Overview

  • COPD is a combination of two conditions: emphysema and chronic bronchitis.
  • It leads to airway obstruction and is irreversible, unlike asthma which is reversible and intermittent.

Pathophysiology

  • Emphysema
    • Destruction of alveoli in the lungs.
    • Leads to decreased lung elasticity, hyperinflation, and air trapping in the lungs.
  • Chronic Bronchitis
    • Inflammation of the airways.
    • Hypersecretion of mucus.
  • Combined effects lead to:
    • Hypoventilation
    • Hypoxemia (low oxygen)
    • Hypercapnia (retention of carbon dioxide)

Risk Factors

  • Smoking (primary risk factor)
  • Air pollution
  • Occupational exposure to chemicals or dust.

Signs and Symptoms

  • Cough
  • Excess sputum
  • Lung sounds: crackles and wheezes
  • Chest percussion: hyper resonance (trapped air)
  • Barrel chest
  • Use of accessory muscles during breathing
  • Clubbing of fingers (spoon-shaped nails)
  • Cyanosis
  • Rapid, shallow respirations
  • Tripod position (to ease breathing)

Diagnosis

  • Decreased oxygen saturation (SpO2) levels, often in the low 90s.
  • Arterial blood gas analysis showing increased PaCO2 and decreased PaO2.
  • Diagnostic tools:
    • Pulmonary function tests
    • Chest x-ray

Treatment

  • Medications:
    • Bronchodilators
    • Anticholinergics
    • Corticosteroids
    • Mucolytics
    • Oxygen therapy

Nursing Care

  • Place the patient in an upright position.
  • Administer oxygen as prescribed.
  • Monitor for complications, such as right-sided heart failure.

Patient Education

  • Encourage cessation of smoking.
  • Teach effective breathing techniques:
    • Abdominal breathing
    • Pursed-lip breathing
  • Teach effective coughing techniques.
  • Teach use of an incentive spirometer (inhale, not exhale into it) - target: 10 times an hour while awake.
  • Dietary advice:
    • Small, frequent meals
    • Increase fluid intake
    • Increase calories and protein intake
  • Oxygen safety:
    • No smoking signs
    • Use of cotton clothing and bedding.

Quiz Questions

  1. Question: COPD includes which two conditions?
    • Answer: Emphysema and chronic bronchitis.
  2. Question: What is the number one risk factor for COPD?
    • Answer: Smoking.
  3. Question: When you percuss the lungs of a patient with COPD, what do you expect to hear?
    • Answer: Hyper resonance due to trapped air.