Hey everyone, it's Sarah with RegisteredNurseAriene.com and in this video I'm going to be doing an NCLEX review over COPD, also called chronic obstructive pulmonary disease. And this video will be part one of a two part series. What I'm going to be covering is the patho of COPD, the signs and symptoms, the different types and how it is diagnosed.
And in part two I'm going to be covering the medications and the nursing interventions. So be sure to check out that part. And as always over here on the side or down in the description below you can access the quiz and the notes that go along With this video, so let's get started first.
Let's start out talking about what is the definition of COPD? What is this? It is a pulmonary disease that causes chronic obstruction of airflow from the lungs So before we get into the pathophysiology and dive into this lecture, let's talk about the key points that you need to remember so whenever we're talking about the patho the signs and symptoms you'll have a little basic understanding of what we're talking about okay so key point one with this disease there is limited airflow and why is this because the bronchioles which you can see right here and this right here is the alveolar sac there is inflammation which has become chronic and has led to this bronchiole becoming deformed and narrow Then you have excessive mucus production.
So it's limiting the amount of oxygen that can get into that bronchial to go to the alveolar sac for gas exchange and it's limiting the amount of carbon dioxide that's coming from the alveolar sac to be exhaled. So you're going to be getting some problems. Another key point is that the patient does not have the ability to fully exhale. And this is due to the loss of elasticity in these alveolar sacs. And here you can see they're mutated looking in a sense.
They're floppy. Your alveolar sacs should be nice and circular and uniform. And here it's completely lost elasticity.
And what your alveolar sacs do is they... inflate and deflate, inflate and deflate. And if they don't have their form, they fully can't do that. And if they can't do that, you're not going to have proper gas exchange. So it's going to throw your blood gases off and air pockets are going to develop over time.
So we'll talk about that especially in your emphysema patients this happens. Okay, so COPD is irreversible. There's not a cure. Cases vary from patient to patient.
Some patients will have a mild case while some will have severe. I've had some patients they cannot talk a complete sentence without stopping taking breaths or hyperventilating during the sentence because they have COPD so bad. And then some patients I've had you wouldn't really know that they had COPD unless you've seen their test results or they told you. So it varies. COPD is managed with lifestyle changes and medications, which we'll really go over in part two with the nursing interventions, patient education, and the medication regimen.
The causes of this. The most common cause of COPD tends to be environmental, from harmful irritants that the person has breathed into their lungs. For example, smoking is a huge cause of this because they're smoking their cigarette, that All those chemicals are constantly entering into the lungs, exhaling, and that wreaks havoc on the pulmonary system over time.
However, this can happen in people who do not smoke. For instance, say they live in an area where there's really bad air pollution or their job. They're around irritants 24-7 or they're a welder, maybe don't wear the protective mask they need to and they can develop this.
And COPD tends to happen gradually. People will start to notice signs and symptoms in middle age. age, they may start to notice that over time they became more short of breath with normal activity they can normally tolerate. They notice that they have this chronic, sometimes productive cough constantly, especially like that smoker. cough in the morning and they're getting recurrent lung infections like pneumonia things like that and then they go to the doctor the doctor runs some tests on them and they have this condition now let's talk about the types of COPD COPD that term is used as a catch-all term for diseases that limit airflow so what we're going to concentrate in this lecture is the one type called chronic bronchitis and emphysema so So let's talk about chronic bronchitis first.
Okay, sometimes you may hear these patients referred to as blue bloaters. Why are they referred to as blue bloaters? Because with emphysema, those patients are referred to as pink puffers. With the blue bloaters with chronic bronchitis, these patients tend to have cyanosis due to the hypoxemia that they're having, the low oxygen, which you will see blue around their lips, mucous membranes, skin, things like that.
And they tend to have edema, swelling in the belly, the legs, because depending on how severe this is, it leads to right-sided heart failure. So let's look at the path, though, of what's happening with chronic bronchitis. Okay, here on the styogram, you have what a normal, healthy lung looks like.
And then over here, you have a lung that's been affected with COPD. Specifically, we have some chronic bronchitis and emphysema going on. First, let's look at the healthy lung and talk about how normally gas exchange goes through this and then we'll compare it with a lung that's experiencing chronic bronchitis.
You breathe in some oxygen. It goes down through your trachea, which your trachea splits at the carina into your bronchus, your right and left bronchus. The right and left bronchus, your primary bronchus, enter into the lungs at the hilum. And then the bronchus even breaks and branches off into further smaller airways like your secondary bronchi, your tertiary bronchi, and then eventually your bronchioles and then your alveolar sacs.
And your alveolar sacs are opening and closing, inflating and deflating for gas exchange. And what helps you to do this breathing is whenever you breathe in your diaphragm, which is normally dome-shaped, it's going to contract and it's going to go down. And this is going to create a negative pressure in your lungs to allow you to breathe.
you to suck in that air which is going to go through gas exchange. Then all that pressure has built up, your diaphragm is going to relax back into its dome-shaped position. From all that increased pressure in the lungs, it's going to cause you to exhale and force that air out so they're constantly inflating and deflating and you keep a nice shape it's not hyperinflated now let's look at the COPD lung with chronic bronchitis so let's say that this person is a smoker and constantly smoking and over time the smoke is going through all these airways and just really messing it up And as what's happened is that over time these little areas you see right here your bronchioles have become inflamed and they start to produce all this mucus. So whenever the person's trying to breathe in, that oxygen can't get to these alveolar sacs because all these narrow little airways and all this mucus in the way.
So oxygen doesn't get in. Then they're trying to exhale that air that they just breathed in. Well, they can't exhale it fully because again, of the narrowing and all that mucus. So they're going to be retaining the...
carbon dioxide. When that patient takes another deep breath in, they're going to be adding more air volume to whatever they already breathed in previously. This is going to lead to, over time, hyperinflation of the lung.
The lung is going to enlarge. When the lung enlarges, you have your diaphragm below your lung. It's going to cause your diaphragm to flatten. Whenever it flattens, you have issues with being able to breathe because your diaphragm does 80% of your breathing and then the patient's going to start using their accessory muscles to breathe which we'll really see with our emphysema patients who are called the pink puffers and that's for that reason. Now let's talk a little bit more about that gas exchange because as I said there's not enough oxygen getting in and we're retaining that carbon dioxide so that person's going to be experiencing what's called respiratory acidosis but because there's not a lot of that oxygen getting in Just to go through gas exchange with you real fast, here's a blown up version of an alveoli.
What happens is that you have capillaries on these alveolar sacs. This capillary is delivering carbon dioxide through this capillary wall to be exhaled because that is a waste product of metabolism and wants to get rid of it. Then these little red blood cells want to get re-oxygenated because right now they're exhausted.
They've done their job through the heart and they need more oxygen. you've breathed in will go through that wall and attach to those red blood cells and then go back to the heart and be pumped through the body and do its job. But here, this is not happening. So what's going to happen, you're going to have low amounts of oxygen. The patient is going to become cyanotic.
They're going to display that cyanosis. Then your body's like, wow, we've really got to compensate for that. Because if you've learned through all of our lectures, every time something bad happens in the body, the body tries to do something with something.
other system to help compensate it and try to save your life. So what happens is that the body will start increasing the production of these red blood cells because it's like, well, if we get some more red blood cells in the system, we can get the body off. oxygenated because we're not getting a lot of oxygen but this causes a problem it causes the blood to become too thick then the body sees well that's not really helping so let's throw some other things in so what will happen is that there There will be an increased pressure in the arteries, specifically your pulmonary artery.
Because remember, your pulmonary artery brings unoxygenated blood to the lungs to become oxygenated. Then that pulmonary vein takes it back to the left side of the heart to be pumped through the body and do its job. So your pulmonary artery is coming from the right side of the heart. So what happens is it starts shifting blood, which is going to increase the pressure in that artery.
And you're going to get what's called pulmonary hypertension. And whenever you get pulmonary hypertension in that artery, what is happening is that that blood is going to start back flowing in that pulmonary artery into that right side of the heart. And we really went in depth in this in our heart failure videos.
And that blood starts backing up, you start getting a lot of problems, it'll affect your liver because you'll get congestion in those hepatic veins and fluid will start building up in the abdomen, eventually into the legs, and it could even lead to left-sided heart failure as well. So that is where the patient is getting the bloating and that's where the blue bloating comes from. Now, let's look at emphysema.
These patients are sometimes called pink puffers. Why is that? Patients with emphysema tend not to have the cyanosis as with the blue bloaters. Why you get the name pink and the puffers comes from what's going on? due to compensation.
Because the body has low O2 levels from what's going on with these alveolar sacs, the body will hyperventilate, increase that respiratory rate. So in a sense, they will be puffing in order to breathe. They're really breathing rapidly to get more oxygen in to increase the oxygen level.
So you'll have no cyanosis and the pink complexion. Now let's look out what's going on up close. Okay.
So what's happened is that say for instance this patient is a smoker and they're inhaling that constant irritant to their lungs What happens is that an inflammation process starts going on because of all that smoke Affecting these sacks and the body actually releases a substance that causes those alveoli sacks to lose their Elasticity so they're not going to be inflating and deflating properly and they become deformed and they don't don't work and whenever that happens it's not good because you're not going to have proper gas exchange happening where those alveolar sacs are inflating and deflating which is allowing that carbon dioxide to pass through that capillary wall so you'll be keeping carbon dioxide It's not going to allow that oxygen to attach to those red blood cells to go through the body. You're going to have low oxygen. Also, another thing that happens is because those sacs are not fully deflating because they don't work good, air is going to get trapped in those sacs, which is going to lead to hyperinflation of the lungs. Whenever the lungs enlarge, remember what's below your lungs is your diaphragm. The diaphragm is going to go from that beautiful...
dome shape to flatten and how you the way you breathe what makes it effortlessly is your diaphragm it plays a huge role in it so to compensate because the lungs have to in a sense squeeze that air out the body is going to start using accessory muscles on your chest to help the person get that air out They're also going to hyperventilate to get that air out and to hopefully get some more oxygen in. This will lead, because they're using their accessory muscles so much, to that barrel chest look that patients with emphysema may have, which is that increased anterior-posterior diameter that you may see on inspection. The hyperventilation again is the compensation to help get that oxygen level where it needs to be.
So that's why you're not going to see cyanosis. They're not going to be blue while they'll have that pink complexion compared to patients who have chronic bronchitis. Now let's talk about the signs and symptoms of COPD. To help you Remember the typical signs and symptoms of COPD?
Let's remember the mnemonic lung damage because that is what is going on with COPD. They have lung damage to the lungs that is limiting the airflow from the lungs. L, they are going to have lack of energy.
And this is because they have a limited supply of oxygen floating through the body. In order for your organs and everything to work properly, it needs oxygen. So anything for them to do is very- hard and requires a lot of effort.
U for unable to tolerate activity. They will get a lot of short, really short of breath. If they have it really severe, even getting them from a chair to back to the bed or walking to the bathroom, it's a big deal and it makes them very short of breath. N for nutrition.
It will be poor, especially with your patients with emphysema. Now let's think back to the patho. Why would they have poor nutrition? Well, they are spending a lot of money on lot of energy breathing and they're burning more calories than normal a person with healthy lungs would burn just with their breathing.
So they're going to have weight loss. Also eating if they have it really really severe and just chewing their food and swallowing their food exhausts them. So they may not be up to eating so you really have to manage that which we'll talk about nursing interventions with your patients with emphysema.
G for gas gases abnormal, those arterial gases. Your PO2, PCO2 will be greater than 45 usually, that's carbon dioxide. And your PO2, which measures your oxygen, less than 90, because remember they have low oxygen and high carbon dioxide.
And usually we'll have respiratory acidosis because of those lab results. D for dry or productive cough. The productive cough, all these coughs will be constant and chronic patients with chronic...
bronchitis tend to have the productive cough because remember they have the increased mucus production from where those bronchioles have become inflamed and they've narrowed so that's why they have that. A for accessory muscle usage for breathing and again that was with your patients with emphysema and that was because that diaphragm has flattened those lungs are hyperinflated so now they their diaphragm is not there to help them exhale that air so they've got to compensate by using those those accessory muscles. The other A for abnormal lung sounds, it can vary. They can be diminished where you don't hear much of anything, especially in those lower bases. Coarse crackles, especially in your chronic bronchitis because of that mucus, that's what you're going to be hearing, or wheezing.
And I have a whole video, if you're not familiar with what these lung sounds sound like, a card should be popping up and you can access the video. It has audio clips where you can actually hear these lung sounds. M for modification of skin color from pink to cyanosis.
And this, again, was with her chronic bronchitis patients. They have a tendency because of their low oxygen will have the blue around the lips or mucous membranes or the skin. A for anterior-posterior diameter increase. That's that barrel chest look.
And that's mainly with the patients who are suffering from emphysema because the usage of those accessory muscles built up. the chest and the hyperinflation of the lungs. G for gets in the tripod position to breathe. A lot of times in order to help these patients breathe whenever they're having difficulty breathing they will get in the tripod position.
This is where they're standing, they're leaning forward while supporting their hands on their knees or on an object. Just being bent over like that helps them breathe better. You may see that sometimes.
And E for extreme dyspnea and that just goes along with everything that's going on. They just get really short of breath. a lot of times.
Now let's look at the complications of COPD and how it is diagnosed. A few complications a patient could experience with COPD is heart disease like heart failure again, we talked about that with the patho especially with the chronic bronchitis patients, it can lead to pulmonary hypertension which will cause increased pressure on that right side of that ventricle and you can get right sided heart failure. Another thing is pneumothorax, where the lung just collapses spontaneously. This tends to be spontaneous in patients who have a history of COPD, and it's because of the formation of those air sacs and those alveoli, especially in your patients with emphysema.
I have had patients who have been admitted with this, so this does happen. I have seen it. Lung infections, pneumonia, for instance.
An increased risk of developing lung cancer. Okay, so how is this diagnosed? From a nursing standpoint, just be familiar with what may be ordered so if you're taking care of a patient with this, you know what to look for for their test results. Physicians will order what's called a spirometry, which is a test where patients breathe into a tube which measures the following.
It's going to measure how much volume the lungs can hold during inhalation. And it's going to measure how much and how fast air volume is being exhaled. Because remember, that's the whole problem with this disease process. They have an issue with retaining too much so they don't exhale too much compared to how much they took in. So it will measure that.
And what it's measuring, the two things mainly, is it's measuring the FVC, which is the force vital capacity. And if they get a low reading on this, this represents restrictive breathing. And this is the largest amount of air exhaled after breathing in deeply in one second. Another thing it looks at is it measures the force expiratory volume, which is how much air a person can exhale within one second. And a low reading will indicate how severe the disease process actually is.
So that is about COPD part one. Now be sure to check out part two and don't forget to take the NCLEX review quiz. that goes along with this lecture. And thank you so much for watching and please consider subscribing to this YouTube channel.