COPD: encompasses 2 diseases > emphysema & chronic bronchitis; Irreversible.

Emphysema is characterized by loss of lung elasticity & hyperinflation of lung tissue; causes destruction of the alveoli, leading to decreased surface area Chronic Bronchitis is inflammation of the bronchi & bronchioles due to chronic exposure to irritants Risk Factors: age, cigarette smoking, Alpha1-antitrypsin deficiency, exposure to air pollution Subjective Data Chronic dyspnea

Objective Data Dyspnea on exertion Productive cough (worse in the AM) Respiratory acidosis Crackles & wheezing Rapid & shallow respirations Use of accessory muscles Barrel chest Irregular breathing pattern Thin extremities & enlarged neck muscles Dependent edema r/t right sided heart failure Clubbing of fingers & toes Pallor & cyanosis of nail beds & mucus membranes Decreased O2 sat

Laboratory Tests Increase Hct r/t low O2 Sputum cultures & WBC counts to dx acute respiratory failure

Diagnostic Procedures PFTs: used for dx & determining effectiveness of therapy; mild COPD the FEV/FVC <70% severe COPD FEV/FVC <50% CXR reveals hyperinflation of alveoli ABGs hypoxemia PaO2 <80

Collaborative Care Nursing Care 1. Position pt in high fowlers to maximize ventilation 2. Encourage coughing & deep breathing 3. Incentive spirometer 4. Promote adequate nutrition a) Increased effort to breathe = more caloric demands b) Nutrition aids in prevention of infection c) Push fluids to promote hydration (2-3L/day to liquefy mucus) d) Soft high calorie foods 5. Proper breathing techniques a) Diaphragm: lie on back w/ knees bent, hand over abdomen to create resistance > if hand raises and lowers upon breathing = doing correctly b) Pursed lip breathing: for the mouth as if going to whistle, deep breath through the nose out through lips, breath in 2 out 3 c) Incentive spirometer: used to monitor optimal lung expansion; instruct pt to form tight seal around mouthpiece, inhale & hold breath for 5 seconds, exhale & needle will rise. 6. Pt may need oxygen: pt with COPD often 2/4L/min; increased CO2 levels usually 1-2L/min. N.C. low arterial levels of O2 serve as primary drive for breathing 7. Offer periods of rest with activity (esp for older adults) Meds 1. Bronchodilators: provide rapid relief 2. Corticosteroids: decrease airway inflammation 3. Antibiotics: kill infections 4. Antitussives: cough suppressant Interdisciplinary Care 1. Respiratory care for inhalers, breathing treatments & suctioning 2. Chest physiotherapy to mobilize secretions 3. Raise foot of bed slightly higher than head to facilitate optimal drainage & removal of secretions by gravity Care after discharge 1. Encourage high calorie diet to promote energy 2. Hand hygiene 3. Reinforce taking meds as prescribed

4. 5. 6. 7.

Smoking cessation Encourage immunizations to decrease r/f infection Use home O2 as prescribed. NO smoking around O2 flammable Avoid O2 complications: CO2 narcosis too much alters brains drive to breathe, pt may not feel need to breathe, slowly adjust up; O2 toxicity prolonged exposure to high levels of O2, administer just enough to maintain O2, no more no less

Complications Cor pulmonale (R. sided heart failure): air trapping, airway collapse, stiff alveoli lead to increased pulmonary pressure; blood flow thru lung tissue is difficult > increases workload > enlargement > thickening to R. atrium & ventricle 1. Manifestations: low O2 levels, cyanotic lips, enlarged/tender liver, JVD, dependent edema 2. Nursing Actions: monitor respiratory status & administer O2 therapy, meds as prescribed, IV fluids & diuretics to maintain fluid balance Respiratory failure: often occurs when a pt waits to long to tell MD when they develop fever, increased cough and dyspnea & other s/s of exacerbations; cor pulmonale may lead to acute respiratory failure as well as stopping of meds 1. Provide adequate O2 2. Monitor ABGs to avoid hypercarbia (high CO2) 3. Important to both above to avoid CO2 narcosis