HEART FAILURE

CAUSES
HTN
Diabetes mellitus predisposes regardless of the presence of CAD and HTN
Cigarette smoking, obesity, high serum cholesterol
Table 36-1
CLINICAL MANIFESTATIONS
1) Fatigue one of the earliest signs of HF. Noticing fatigue during activities that normally did not
cause fatigue. Caused by decreased CO, impaired perfusion to vital organs. decreased
oxygenation to tissues, & anemia
2) Dyspnea caused by increased pulmonary pressures secondary to interstitial and alveolar
edema. Often need pillows at night to relieve SOB, and pt presents with dry, hacking cough not
relieved by position or over the counter cough suppressants
3) Tachycardia early clinical sign of HF. Increasing HR d/t decreased CO, increased HR
stimulated by SNS
4) Edema 2 kg weight gain in 2 days is often indicative of exacerbated H
5) Nocturia up to 6-7 times/night. d/t fluid movement from interstitial space back into circulatory
system = improved renal perfusion.
6) Skin changes d/t impaired perfusion. Dusky, cool, shiny and swollen. Chronic swelling can
cause changes in skin colour = looks more brown
7) Behavioural changes d/t impaired cerebral perfusion from decreased CO. Restlessness,
confusion, or decreased memory or attention span
8) Chest pain d/t decrease CO
9) Weight changes weight gain d/t edema. Weight loss, fatigue = not eating or feeling to sick to
eat. Abdominal fullness from ascites and heptamegaly causing nausea and anorexia
COMPLICATIONS
1) Pleural effusion
2) Dysrhythmias enlargement of heart causes alterations in normal electrical pathways
3) Left ventricular thrombus d/t enlargement of heart = increased risk from emboli formation
4) Hepatomegaly impaired function, leading to fibrosis and subsequently cirrhosis
5) Renal failure
NURSING MANAGEMENT
1) Decreasing intravenous volume loop diuretic (furosemide), helps reduce preload, letting the
LV contract more efficiently = improved CO
2) Decreasing venous return (preload) placing client in high-fowlers with the feet horizontal in
the bed or dangling at the bedside. This position also improves thoracic capacity. IV nitro
3) Decreasing afterload by doing this the CO of the LV improves and thereby decreases
pulmonary congestion. IV nitroprusside (Nipride) is a potent vasodilator and reduces pre and
afterload (but should only be consider from SBP > 100mmHg). Morphine also reduces
pre/afterload but dilating pulmonary and systemic blood vessels.
4) Improving gas exchanges and oxygenation IV morphine by decreasing oxygen demands
(but must monitor for RD). Supplementary O2 to keep sats > 95%, for pulmonary edema
potential use of ventilator support (BiPAP) or intubation and mechanical ventilation.
5) Improved cardiac function for the pt that progressively becomes hypotensive, has a HR that
is abnormally fast or slow, develops dysrhythmias, or becomes hypoxic with cool and clammy
skin, = nursing care becomes more urgent and treatment protocols may call for aggressive,

complex therapies. Use of diuretics, morphine, vasodilators, may not be sufficient. Use of
positive inotrops.
6) Reducing anxiety sedative action of morphine,
COLLABORATIVE CARE
Main goal = treat underlying cause and contributing factors maximize CO provide treatment to alleviate symptoms
Oxygen saturation, and use of pulse oximetry
Regular exercise for all pts with stable chronic CHF. (3-5 days/week @ 30-45 mintues). But a
graded exercise test should be performed first and with the involvement in a cardiac rehabilitation
program will provide the client with an individualized exercise regimen
Non-pharmacoligcal therapies the use of a Cardiac resynchronization therapy (CRT). Helps
coordinate right and left contractility through biventricular pacing. Normal electrical pathways in
left and right ventricle improves LV function and CO. Also helps improve exercise. Does not
prolong life, but improves QOL.
Cardiac transplant
DRUG THERAPY
1) Diuretics to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload.
Can reduce blood volume returning to heart, and improve cardiac function
Thiazides are first choice
Loop diuretics used more so for acute HF and pulmonary edema
2) ACE inhibitors (pril) first line therapy for systolic and diastolic HR. Reduces SVR, decreasing
afterload, improving CO. Improved CO = improved tissue perfusion, reduced pulmonary artery
pressure, right arterial pressure, LV filling pressure.
SE symptomatic hypotension, chronic cough, renal insufficiency in high doses
Because of SE, these drugs should be started at a low dose and slowly increased over a 23 month period
Monitoring BP and renal function at regular intervals
If pt unable to tolerate ACE switch to ARBs
3) -adrenergic Blockers (lol) in combo with ACE has become standard therapy in managing HF.
Block negative effects of SNS, such as increased HR.
SE edema, hypotension, fatigue, asthma exacerbations, bradycardia
Because this drug can reduce myocardial contractility, care must be taken to start
gradually
4) Inotropic drugs improves contractility of heart = improved CO, decreased LV diastolic
pressure, decreased SVR
a. Sympathomimetic agents increases heart contractility, usually used in acute situations
dopamine (Inotropin),
dobutamine (Dobutrex),
epinephrine (Adrenalin),
and norepinephrine (Lovephed)
b. Phosphodiesterase inhibitors enhance calcium entry into cells and improve myocardial
contractility. Potent vasodilators, increase CO and reduce arterial pressure (decrease
afterload). Short term use in critical care setting, not in oral form
Milrinone (Primacor)
c. Digitalis preparations decreasing conduction speed, positive inotropic effect, A. Fib,
and rapid ventricular rate
Closely monitor for toxicity

Toxicity incidence increase with presence of hypokalemia (pt on lasix, or

thiazides), renal dysfunction, or dehydration

Manifestations of Digitalis Toxicity

Cardiovascular system
Bradycardia; tachycardia; pulse deficit; dysrhythmias, including premature ventricular contractions, first
degree atriventricular blocks, atrial fibrillation, junctional rhythms
Gastrointestinal system
Anorexia, N&V, diarrhea, abdominal pain
Neurological system
Headache, drowsiness, confusion, insomnia, muscle weakness, double vision, halo vision, coloured vision
(usually green or yellow), vision halos
d. Vasodilator drugs improve survival of the overt heart. 1) increase venous capacity, 2)
improve EF through improved ventricular contraction 3) slowing the process of
ventricular dysfunction 4) decreasing heart size 5) avoiding stimulation of the
neurohormonal responses initiated by the compensator mechanisms of HF
Nitrates reduce myocardial ischemia. men who take nitrates should not take
erectile agents since together these drugs could precipitate profound hypotension
Sodium nitroprusside
e. Human B-type Natriuretic Peptide synthetic form of human BNP
Nesiritide
NUTRITIONAL THERAPY
Diet education and weight management are critical to the clients control of chronic HF
The client should be taught the foods that are high and low in sodium, and alternative ways to
flavour foods (substituting lemon juice and various spices)
Edema is often treated with sodium restrictions
Diets that are severely restricted in Na are rarely prescribed because they are unpalatable and
client compliance is low
DASH diet is effective as first-line therapy for pts with isolated systolic HTN
Mild HF = 2g of salt/day more severe = 1g/day
With the more severe diet milk, cheese, bread, cereals, canned coups and some canned
vegetables must be eliminated
Clients are advised to do the following
o Stop using the salt shaker (remove from the table)
o Do not add salt to food during preparation
o Read food labels carefully
o Stop eating process and high-sodium foods; the greatest source of sodium (up to 80%) is
the salt and other sodium compounds added to foods during processing
o Be aware of hidden sources of Na (bread {150mg of salt})
Restrict fluid to 1.5-2L/day (6-8 glasses a day) this includes foods like ice cream and fruits
Weight self daily
o If a client experiences weight gain of 2 kg over a 2- to 5-day period; the primary care
professional should be called
Implantable Cardioverter-Defibrillator (ICD)
The ICD sensing system monitors HR and the rhythm and identifies V. Tach or V. Fib.

After 25 seconds of detecting lethal rhythm, the defibrillating mechanism delivers a 25-joule or
less shock to the heart. If the first shock is unsuccessful, the generator recycles and can continue
to deliver shocks
Equipped with antitachycardia and antibradycardia
Pt education
o Keep incision site dry for 1 week post surg
o Avoid lifting operative arm above shoulder for 1 week
o Inform airport security when flying
o When the ICD fires
Lie down
If the client looses consciousness or if there is repetitive firing, call 911
If the client is feel well and there is repetitive firing, contact the physicians office
for ICD interrogation, including battery checks and safety and diagnostic checks
o Routing ICD check q2-3 months
o Family members should learn CPR
o Should not drive until cleared by Dr.
Pacemakers
used to pace the heart when normal conduction pathway is damaged or diseased
the myocardium is captured and stimulated to contract
pacemakers were initially for symptomatic bradydysrhythmias, but now used also for
antitachycardia and

HYPERTENSION
Hypertension = sustained elevated BP
Classification of HTN
Category
Optimal

Systolic
<120

Normal
High-normal
Grade 1 (mild HTN)
Grade 2 (moderate HTN)
Grade 3 (severe HTN)
Isolated systolic HTN (ISH)

<130
130-139
140-159
160-179
>180
>140

and/or
and/or
and/or
and/or
and/or
and/or

Diastolic
<80
<85
85-89
90-99
100-109
>110
<90

**requires assessment of
overall cardiovascular risk
**require annual BP readings

**In general, BP should be lowered to less than 140/90, and those who are diabetic or have chronic
kidney disease 130/80
Diagnostics
based on several elevated readings
basic lab studies are performed to evaluate target-organ disease, determine overall cardiovascular
risk, and establish baseline levels before initiating therapy

routine urinanlysis and creatinine levels are used to screen for renal involvement and to provide
baseline information about the kidneys
serum electrolytes potassium
ECG baseline of cardiac status
Fasting glucose
Urinary albumin in diabetic patients

Life style modifications are effective in reducing BP and cardiovascular risk

Dietary changes
o Restrict sodium (65-100mmol/day
o Maintenance of dietary potassium, calcium and magnesium
o Calorie restriction for the overweight patient
Reducing sodium and fat intake
Waist circumference
o Women <88cm
o Men <102cm
o Eat several fish/week, lots of F&V, increasing fibre intake, drinking plenty of water
Limitation of alcohol
o 2 drinks/night
o 14 drinks/week for men
o 9 drinks/week for women
Regular physical activity
o 30 minutes or more of moderate intensity activity, preferably all days of the week
Avoidance of tobacco use
o Nicotine causes vasoconstriction and increased BP
o Cardiovascular benefits of cessation of smoking can be seen within 1 year
Stress management
o Relaxation therapy
o Guided imagery
o Biofeedback
Combination therapies (both drug and lifestyle) are generally necessary to achieve target BP
DRUG THERAPY
Many side effects from drugs but may disappear over time
Orthostatic HTN, teach client safety measures
Sexual dysfunction
HEALTH PROMOTION
Current recommendations for primary prevention are based on lifestyle modifications that have
been shown to prevent or delay the expected rise in BP in susceptible people
A diet rich in F&V, low fat dairy foods, with reduced saturated fats and total fats significantly
lower BP
THE OLDER ADULT
Higher BP over the age of 60 is common
1) Loss of tissue elasticity

2) Increased collagen content and stiffness of the myocardium

3) Increased PVR
4) Decrease alpha-adrenergic receptor sensitivity
5) Blunting of baroreceptor reflexes
6) Decreased renal function
7) Decreased rennin response to sodium and water depletion
So essentially, BP in the older adult is common because of the physiological changes that occur
during the aging process

ANGINA & MYOCARDIAL INFARCTION

CAD = blood vessel disorder including atherosclerosis
Metabolic syndrome = is a cluster of risk factors for CAD
Health Promotion in CAD
Identify people at risk for CAD
Cannot change the non-modifiable factors age, sex, race and genetic inheritance
Encourage and motivate to change the modifiable risk factors
Teach health-promoting behaviours to the person at risk for CAD
Physical activity,
Nutritional therapy
o Lower LDL cholesterol (fat should be about 30% of calories with most coming from
monounsaturated fats found in nuts and oils such as olive or canola oil). Red meats, eggs,
and whole milk products are major sources of saturated fat and cholesterol and should be
reduced or eliminated
ANGINA is a manifestation of CAD
Angina occurs when the demand for myocardial oxygen exceeds the ability of the coronary
arteries to supply to the heart with oxygen
Angina is the clinical manifestation or reversible myocardial ischemia
CHRONIC STABLE ANGINA
Chest pain that occyrs intermittently over a long period with the same pattern of onset, duration
and intensity of symptoms. (pain = pressure of aching)
Usually only lasts 3-5 minutes and commonly subsides when the precipitating factor is relieved
Silent ischemia ischemia that occurs in the absence of any subjective symptoms
o Clients with diabetes are at increased risk for silent ischemia
Prinzmetals Angina often occurs at rest, usually in response to spasm of a major coronary
artery
Managing Chronic Stable Angina
Aimed at decreasing oxygen demand or increasing oxygen supply or both
Reduce risk factors is a priority
Drug therapy
o Short acting nitrates (first line therapy)
Dilates peripheral blood vessels
Dilates coronary arteries and collateral vessels
Sublingual (Nitrostat), translingual spray (Nitrolingual), relieves pain with 3
minutes, with durations of 30-60 minutes

If 1 pill or 1 stay does not relieve within 5 mintues, the client should be
instructed to contact EMS
It is okay if the patients feels a tingling sensation, nitro causes a tingling
sensation
If tingling is not felt and pain is unrelieved, call for help
SE increase in HR, pounding h/a, dizziness, flushing, caution against risking
to a standing position because of orthostatic hypotension
o Long acting nitrates
Isosorbide dinitrate (Isodril) or isosorbide mononitrate (Imdur)
Used to reduce the incidence of angina attacks
SE main is a headache (Tylenol can be give with nitrate to relieve headache),
orthostatic hypotension
Client should schedule a 8-hr nitro free time, ex. during night
o Beta-Adrenergic Blockers (olol)
Preferred drug to manage angina
Decrease myocardial contractility, HR, SVR, and BP all reducing myocardial
oxygen demand
SE bradycardia, hypotension, wheezing and GI complaints
Should be avoid in clients with asthma (as it can cause bronchoconstriction?)
And can mask hypoglycemia in diabetic patients
o Calcium Channel Blockers (VND)
In contraindication/poor tolerance/ or poor control of angina symptoms to betablocker
Effects systemic vasodilation with decrease SVR, decreased myocardial
contractility, and coronary vasodilation
CCB can potentiate the action of digoxin by increasing serum digoxin levels
Therefore close monitoring for toxicity, and teach S&S of toxicity
o ACE inhibitors (prils)
High risk clients can benefit from the addition of ACEI
Diagnostics
o Detailed health history and physical examination
o Chest radiography to look for cardiac enlargement, aortic calcifications, pulmonary
congestion
o 12 lead- ECG
o Labs tests and diagnostic studies (Holter monitoring, echocardiogram)
o Clients with known CAD and stable angina
ECG
Echocardiogram
Exercise stress test
Pharmacological nuclear imaging
Coronary angiogram

ACUTE CORONARY SYNDROME

Myocardial ischemia prolonged and not immediately reversible
Involves unstable angina, NSTEMI & STEMI
Deterioration of a once stable atherosclerotic plaque
UNSTABLE ANGINA

 Chest pain that is new in onset, occurs at rest, or has a worsening pattern
It is unpredictable and represents an emergency!!
UA in women = fatigue, SOB, indigestion, anxiety
MYOCARDIAL INFARCTION
Sustained ischemia, causing irreversible myocardial cell death (necrosis)
Clinical manifestations
o Pain not relieved by rest, position change, or nitrates
Most likely to occur in the morning hours
And older adult may experience a change in mental status, SOB, pulmonary
edema, dizziness, or dysrhythmias
o SNS stimulation
Release of glycogen, diaphoresis, vasoconstriction of peripheral blood
vessels,
Client skin = ashen, clammy, cool to touch
o Cardiovascular manifestations
In response to catecholamines initial increase in BP and HR
BP will drop later because of decreased CO
Decrease renal perfusion and thus decrease urinary output
Crackles over the lungs (indicating left ventricular dysfunction)
JVD, hepatic engorgement and peripheral edema (indicating right ventricular
dysfunction)
o N&V
o Fever increased in the first 24 hrs up to 38 and occasionally up to 39 and can last
up to 1 week.
Acute intervention
o ***it is extremely important that a client with ACS is rapidly diagnosed and
treated to preserve cardiac muscle.
Priorities pain assessment and relief, physiological monitoring, promotion of rest and
comfort, alleviation of stress and anxiety,
Pain
o Nitroglycerin, morphine sulphate (also has dilating effects), and supplemental
oxygen
Monitoring
o Continuous ECG monitoring, vital signs, intake and output, physical assessment to
assess for deviations for baseline, assess oxygenation status
Rest and comfort
o Best rest for several days if severe
o Rest in a chair for 8-12 hours if uncomplicated MI
o Rest and comfort takes unnecessary work off of the heart
o Gradual workload is increased
Anxiety
o Pt afraid of being alone have family member stay with patients
o Fear of unknown explore concerns with client and help with appropriate reality
testing
o Anxiety d/t lack of information provide teaching appropriate to clients stated
needs and level
o Answer questions simply and clearly

 Emotional and behavioural reactions

o Enhance social supports for client
Diagnostics
ECG
Serum cardiac markers
o Released in response to necrotic heart muscle post MI
o Creatine kinase (CK) CK-MB band is specific to the heart and helps quantify
myocardial damage
o Troponin released after myocardial injury, highly specific to MI
Coronary angiogram
o Evaualtes the extent of the disease and determines the most appropriate therapeutic
modality
o This is the only way to diagnose Prinzmetals angina
Collaborative Care
establish IV, sublingual nitro and aspirin, morphine IV, oxygen 2-4L/min
Percutaneous coronary intervention inflatable balloon tip is inserted into a narrowed
artery
o First in therapy for confirmed MI (goal = open artery within 90 minutes of coming to
hospital)
Fibrinolytic therapy given ideally within 1-6 hours of onset of symptoms
o Ongoing assessment for bleeding
Drug therapy
o IV nitro
o Morphine sulphate
o B-blockers
o ACEI
o Antidysrhytmia drugs
o Cholesterol-lowering drugs
o Stool softeners
CABG = palliative for CAD not curative
Complications dysrhythmias, heart failure, cardiogenic shock, papillary muscle dysfunction,
ventricular aneurysm, pericarditis, Dresslers syndrome (percarditis with fever and effusion within 4-6
weeks post MI)
Healing Process
Inflammatory response
10-14 days myocardium is still considered vulnerable to increased stress because of the unstable
state of the healing heart wall
6 weeks post MI, scar tissue replaces necrotic tissue = healed
Home and Ambulatory Care
Client should be able to identify precipitating factors of angina
Avoidance of extreme temperatures, and consumption of large, heavy meals (adequate rest 1-2
hours if heavy meal is consumed)
Physical activity brisk walk on a flat surface at least 30 minutes a day, 5 or more days a week
Ensure proper use of nitro

Client Teaching
For teaching to be meaningful, the patient needs to be aware of the need to learn
Teaching when shock and disbelief are reduced is most effective
Physical Activity
o In the hospital, the activity level is gradually increased so that by the time of discharge,
the client can tolerate moderate energy activities
o Because of the clients short stay at the hospital, it is critical to give the client specific
guidelines for physical activity so that an over-exertion will not occur.
Stress that the client should listen to what the body is saying which is the
most important facet of recovery
o Teach the client how to check the pulse rate this is a nursing responsibility
o Pt should be taught to stop exercise if dyspnea or angina occurs
o Use FITT for exercise
Resumption of Sexual Activity
o Sexual activity for middle-aged men and women with their usual partner is mo more
strenuous than climbing two flights of stairs.
o It is no uncommon for a client who experiences chest pain on physical exertion to have
some angina during sexual stimulation or intercourse
o Take nitro prophylactically
o Avoid having sex soon after a heavy meal or after excessive ingestion of alcohol, when
extremely tired or stressed, or with unfamiliar partners
o Avoid hot or cold showers before or after sex
o Foreplay is desirable because it allows a gradual increase in HR
o NOTE THAT use of erectile agents are contraindicated if taking nitrates in any form
o Anal intercourse is to be avoided because of the likelihood of eliciting a vasovagal
response
o Resumption of sex depends on the client and his or her partners emotional readiness and
on the physcians assessment of the extent of recovery
o It is now known that it is afe to resume sexual activity 7-10 days day an uncomplicated
MI
o Some physicans believe that the client should decide when he or she is ready to resume.
Whereas others believe that if a client is able to climb two flights of stairs briskly without
dyspnea or angina before sexual activity can be resumed
Sudden Cardiac Death
Sudden death from cardiac causes
CAD is most common cause of SCD
Abrupt disruption in cardiac function, producing an abrupt loss of CO and cerebral blood flow
Can be caused by ventricular dysrhythmias (V. Tachy or V. Fib)
In individuals with or without MI history

ASTHMA
Patho
Early-response characterized by bronchospasm with mucous secretion, edema formation,
increased amounts of tenacious sputum (causing, wheezing, cough, chest tightness, SOB)
o Peak 30-60 minutes

o Subsides in another 30-90 minutes

Late-response can be more severe than early-phase
o Peak 5-12 hours after early phase
o Characterized primarily by inflammation
o Corticosteroids are effective in preventing and reversing this cycle
If airway inflammation is not treated or does not resolve, it may eventually cause progressive,
irreversible lung damage

Clinical Manifestations
Wheeze, breathlessness, chest tightness or cough, or combination
Expriation is prolonged, (1:3-4) d/t bronchoconstrcition, takes longer for air to move out of lungs
Wheezing is an unreliable sign to gauge the severity of an attack
o Minor attack can manifest with loud wheezing
o Whereas severe attacks can manifest with no wheezing (d/t marked reduction in airflow)
o Wheezing usually occurs first on exhalation, and as it progresses can occur during both
inhalation and exhalation
o Silent chest = severely diminished or absent breath sounds = ominous sign
Cough variant asthma asthma where the client only manifests a cough
Hypoxemia, restlessness, increased anxiety, inappropriate behaviour, increase HR and BP, pulsus
paradoxus (which is a drop in systolic pressure during the inspiratory cycle greater than 10 mm
Hg), increased RR (>30bpm), accessory muscle use, difficutly speaking,
***Once asthma control has been maintained for several months, an attempt should be made to reduce
medication while maintain acceptable asthma control
General Management
1) Develop partnership between health care professionals and client and families affected
2) Limit exposure to triggers
3) Educate clients
4) Offer appropriate pharmacotherapy
5) Continuously assess and monitor asthma control and severity
6) Implement an action plan
7) Ensure regular follow up
All indivudlas with asthma need to have access to an inhaled short acting B2-agonist for quick relief of
symptoms
Environmental Control
Client needs to be able to identify triggers and reduce exposure to known triggers
Pet allergens are a common allergen removal of the pet is the most effective means to reduce
the exposure, however this is foten not a realistic option for clients and families
Instead, exclude the pet from the bedroom, use air cleaners, frequent vacuuming, and washing the
pet
For parents that smoke they should not be allowed to smoke in cars or houses where
individuals with asthma are present
Use of scarves and facial masks to reduce exposure to cold air
Use of bronchodilator 10-15 minutes before exercise to reduce chances of asthma attack
***every individual with asthma should have an asthma action plan

Nurses must facilitate the attainment and effective use of an individualized asthma action plan
developed in partnership with client and their families.
Status Asthmaticus
Severe, life threatening asthma attack that is refractory to usual treatment and places the client at
risk for respiratory failure
the longer it lasts, the worse it gets, and the worse it gets, the longer it lasts
The clinical manifestations are similar to those of asthma, but are more severe and prolonged
Absence of wheeze is a life-threatening situation that may necessitate mechanical ventilation
The chest appears fixed, in a hyperinflated position and is often described as tight, indicating
severely decreased movement of air through the constricted bronchial airways
Pulsus paradoxus of > 40mmHg
HTN, sinus tachycardia, and ventricular dysrhythmia
Once client becomes fatigued, CO2 retention occurs
Complications include
o Pneumothorax
o Pneumonediastinum
o Acute cor pulmonale with right ventricular failure
o Severe respiratory muscle fatigue leading to respiratory arrest

COPD:
Chronic Bronchitis & Emphysema
Emphysema hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary
walls, narrowed, tortuous small airways, loss of lung capacity
Elastin, collagen and supporting structures are destroyed
Air goes into the lungs easily, but is unable to come out on its own and remains in the lung
Air trapping in the lungs cause hyperinflation of the lungs and can give the client a barrel-chest
appearance
Decreased surface area available for O2 diffusion
Hypercapnia and respiratory acidosis do not develop until late in the disease process
Chronic Bronchitis excessive production of mucous in the bronchi accompanied by a recurrent cough
that persists for at least 3 months of the year during at least 2 successive years
Hyperplasia of mucous-secreting glands in the trachea and bronchi, increased goblet cells,
disappearance of cilia, chronic inflammatory changes and narrowing of small airways, altered
function of alveolar macrophages, leading to increased bronchial infections
Alveolar structures and capillaries are normal
Inflammatory process causes vasodilation, congestion, and mucosal edema
Hypoxemia and hypercapnia develop more often
Diminished respiratory drive, with tendency to hypoventilate and retain CO2
Cough is often ineffective at removing secretions adequately because the peson cannot inspire
deeply enough to cause air to flow distal to retained secretions
Clinical Manifestations cough, dyspnea, weight loss and anorexia, fatigue, edema (if right sided heart
involved), polycythemia, hypoxemia, during exercise prolonged expiratory phase, wheeze, decreased
breath sounds

Complications
1) Cor Pulmonale hypertrophy of the right side of the heart, with or without heart failure,
resulting from pulmonary HTN
2) AECOPD sustained worsening dyspnea, cough, or sputum production leading to increased use
of maintenance medications or supplemention with additional medciations. May be caused by an
infection (use of antibiotics)
3) Acute Respiratory Failure as a result of AECOPD
4) Depression, Anxiety, & Panic
Collaborative Care
1) Prevent disease progression (smoking cessation has shown significant slowing of disease process)
2) Reduce the frequency and severity of exacerbations
3) Alleviate breathlessness and other respiratory symptoms
4) Improve exercise tolerance and daily activity
5) Treat exacerbations and complications of the disease
6) Improve heatlh status and quality of life
7) Promote client comfort and participate in care
**bronchodilators are the mainstay of pharmacological therapy for COPD
Oxygen Therapy
Indications in clients who experience hypoxia
Most methods of O2 administration are low-flow devices