Chronic Obstructive Pulmonary Disease

SUBMITTED BY: RUBANG, Ryan Estabillo RULLAN, Mark Lester SAQUING, April Beatriz Nieveras BSNURSING IV-2 SUBMITTED TO: ECHAVARRE, Charmae GADIA, Micalyn NONES, Kevin EVANGELISTA, STUDENT HEAD NURSES BACNOTAN DISTRICT HOSPITAL WARD 7-3

Chronic Obstructive Pulmonary Disease

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD:   Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves destruction of the lungs over time

Most people with COPD have a combination of both conditions. Symptoms Cough, with or without mucus Fatigue Many respiratory infections Shortness of breath (dyspnea) that gets worse with mild activity  Trouble catching one's breath  Wheezing     Causes, incidence, and risk factors Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are:     Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution Frequent use of cooking fire without proper ventilation Genetics Some factor in addition to heavy smoke exposure is required for a person to develop COPD. This factor is probably a genetic susceptibility. COPD is more common among relatives of COPD patients who smoke than unrelated smokers

Diagnostic tests  Spirometry -the best test for COPD is a lung function spirometry . This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away, and the test does not involve exercising, drawing blood, or exposure to radiation.  Auscultation - using a stethoscope to listen to the lungs can also be helpful. However, sometimes the lungs sound normal even when COPD is present.  X-rays and CT scans - pictures of the lungs (such as x-rays and CT scans) can be helpful, but sometimes look normal even when a person has COPD (especially chest x-ray).  Arterial blood gas- sometimes patients need to have a blood test (called arterial blood gas) to measure the amounts of oxygen and carbon dioxide in the blood. Nursing Interventions for patient with COPD  Maintaining a patent airway is a priority. Use a humidifier at night to help the patient mobilize secretions in the morning. Encourage the patient to use controlled coughing to clear secretions that might have collected in the lungs during sleep. Instruct the patient to sit at the bedside or in a comfortable chair, hug a pillow, bend the head downward a little, take several deep breaths, and cough strongly  Ad minister low concentrations of oxygen as ordered. Perform blood gas analysis to determine the patient's oxygen needs and to avoid carbon dioxide narcosis.  Teach patients and family that excessive oxygen therapy may eliminate the hypoxic respiratory drive, causing confusion and drowsiness, signs of carbon dioxide narcosis.  Emphasize the importance of a balanced diet. Because the patient may tireeasily consider using oxygen, administered by nasal cannula, during meals.  Help the patient and his family adjusts their lifestyles to accommodate the limitations imposed by this debilitating chronic disease.  Instruct the patient to allow for daily rest periods and to exercise daily as his physician directs.  As the disease progresses, encourage the patient to discuss his fears.

 To help prevent COPD, advise all patients, especially those with a family history of COPD or those in its early stages, not to smoke.  Assist in the early detection of COPD by urging persons to have periodic physical examinations, including spirometry and medical evaluation of a chronic cough, and to seek treatment for recurring respiratory infections promptly.  Patient teaching for patient with COPD  Teach the patient and his family how to recognize early signs of infection; warn the patient to avoid contact with people with respiratory infections. Encourage good oral hygiene to help prevent infection. Pneumococcal vaccination and annual influenza vaccinations are important preventive measures.  To promote ventilation and reduce air trapping, teach the patient to breathe slowly, prolong expirations to two to three times the duration of inspiration, and to exhale through pursed lips.  To help mobilize secretions, teach the patient how to cough effectively.  If the patient is to continue oxygen therapy at home, teach him how to use the equipment correctly.  Be sure the patient and family understand any medication prescribed, including dosage, route, action, and side effects.  Instruct the patient to report any signs and symptoms of infection to the primary healthcare provider. Explain necessary dietary adjustments to the patient and family.  Recommend eating small, frequent meals, including highprotein, high-density foods.  Encourage the patient to plan rest periods around his or her activities, conserving as much energy as possible. Arrange for return demonstrations of equipment used by the patient and family.  Refer the patient to the appropriate rental service, and explain the hazards of combustion and increasing the flow rate without consultation from the primary healthcare provider, if the patient requires home oxygen therapy.

MEDICAL MANAGEMENT  Medications used to treat COPD include:  Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol  Inhaled steroids to reduce lung inflammation  Anti-inflammatory medications such as montelukast (Singulair) and roflimulast are sometimes used  In severe cases or during flare-ups, you may need to receive:  Steroids by mouth or through a vein (intravenously)  Bronchodilators through a nebulizer  Oxygen therapy  Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube) Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse. You may need oxygen therapy at home if you have a low level of oxygen in your blood. Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise can help maintain muscle strength in the legs. Walk to build up strength.     Ask the doctor or therapist how far to walk. Slowly increase how far you walk. Try not to talk when you walk if you get short of breath. Use pursed lip breathing when breathing out (to empty your lungs before the next breath)

Things you can do to make it easier for yourself around the home include:  Avoiding very cold air  Making sure no one smokes in your home  Reducing air pollution by getting rid of fireplace smoke and other irritants  Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about eating foods with more calories.

Surgery may be used, but only a few patients benefit from these surgical treatments:  Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema  Lung transplant for severe cases

Sources: en.wikipedia.org/wiki/chronic_obstructive_pulmonary_disease www.ncbi.nlm.nih.gov

POST TEST ON CHRONIC OBSTRUCTIVE PULMONARY DISEASE ( 10points )

Name: Year & Section: Score: Direction: Write the answer that best corresponds to the question. No erasures. : 1. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen? A. Limiting fluid B. Having the client take deep breaths C. Asking the client to spit into the collection container D. Asking the client to obtain the specimen after eating 2. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician? A. Dry cough B. Hematuria C. Bronchospasm D. Blood-streaked sputum

3. The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching? A. Make inhalation longer than exhalation. B. Exhale through an open mouth. C. Use diaphragmatic breathing. D. Use chest breathing.

4. The nurse assesses a male clients respiratory status. Which observation indicates that the client is experiencing difficulty breathing? A. Diaphragmatic breathing B. Use of accessory muscles C. Pursed-lip breathing D. Controlled breathing

5. A female client is undergoing a complete physical examination as a requirement for college. When checking the clients respiratory status, the nurse observes respiratory excursion to help assess: A. Lung vibrations. B. Vocal sounds. C. Breath sounds. D. Chest movements.

6. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and cant produce an effective cough, the nurse should monitor closely for: A. Pleural effusion. B. Pulmonary edema. C. Atelectasis. D. Oxygen toxicity.

7. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A. It helps prevent early airway collapse. B. It increases inspiratory muscle strength. C. It decreases use of accessory breathing muscles. D. It prolongs the inspiratory phase of respiration.

8. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD? A. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive. B. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator. C. It stimulates adenosine receptors, causing bronchodilation. D. It alters diaphragm movement, increasing chest expansion and enhancing the lungs capacity for gas exchange.

9. A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient? A. Activity intolerance related to fatigue B. Anxiety related to actual threat to health status C. Risk for infection related to retained secretions D. Impaired gas exchange related to airflow obstruction

10. For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? A. Encouraging the patient to drink three glasses of fluid daily B. Keeping the patient in semi-fowlers position C. Using a high-flow venture mask to deliver oxygen as prescribe D. Administering a sedative, as prescribe